Partial Hospitalization Program Referral

We currently have a high volume of requests and partner with mental health agencies outside of CHKD to ensure all children referred receive appropriate treatment resources. Please give our team 5-10 business days to review referrals and connect families to the appropriate resources.

If your patient has an urgent/acute mental health concern and they require immediate assessment, recommend mental health evaluation at the closest emergency room or the CHKD Emergency Department or call 911.

This form can be submitted electronically using the submit button at the bottom of this page. If you prefer to print and fax this form, download a copy here and fax it to (757) 668-8870.