Mindful Health NW

Use this form to make a referal to Portland Mental Health & Wellness (PMHW) for mental health services. This referral initiates our clinical review and intake process and helps ensure the patient is matched with an appropriate level of care.

Submitting this form does not guarantee immediate placement. Our team will review the information provided, assess clinical fit and availability, and follow up directly with the patient or referring party regarding next steps.

Please complete this form as fully and accurately as possible. The information you provide supports:

• Clinical appropriateness review

• Determination of service type and acuity

• Timely follow-up with the patient

Incomplete or unclear referrals may delay outreach or require additional clarification before we can proceed.

If you are referring on behalf of a patient, please ensure you have the patient’s consent to share this information.

After submission:

1. Our intake team will review the referral for clinical fit and service availability.

2. If appropriate, we will contact the patient directly to discuss services, scheduling, and next steps.

3. If we are unable to accept the referral, we will make reasonable efforts to notify the referring party and/or provide alternative recommendations when possible.

Please note that response times may vary based on clinical demand and capacity.