Ellie Express- Young Adult Psychosis Intensive Outpatient Program (IOP) Referral Form
Young Adult Psychosis - IOP is a 9-week intensive outpatient program for adults experiencing their first episode of psychosis. This program utilizes key concepts from the NAVIGATE program, NAMI, OnTrackNY, and other evidence-based treatment modalities to work towards recovery after an initial episode of psychosis. Young Adult Psychosis IOP focuses on reduction in symptoms, reduction in substance use, healthy lifestyle choices, and stress management. Clients use these skills to work towards individual goals, often returning to work or school and improving overall functioning. Our IOP program meets 4 days per week from 1:00 pm- 4:00 pm (Tuesday, Wednesday, Thursday, and Friday). In addition, clients participate in Individual therapy sessions on Mondays. This IOP is located at our Maple Grove Ellie clinic. If you have any questions, please call 651-313-8080 Option 4 between the hours of 8:00am and 4:30pm CST Monday through Friday.
Ellie Express- Young Adult Psychosis-IOP Services at Ellie
To request IOP services, please complete the following form and email a cover letter, updated clinical records, and a Release of Information to eep@elliementalhealth.com. A member of the Ellie team will be in contact with you in 1-2 business days.
This program is expected to begin May 16th
Is this patient 18-35 years old?
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Yes
No
When is the discharge date?
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Month
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Day
Year
Date
Name of attending Doctor
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First Name
Last Name
Name of attending Social Worker
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First Name
Last Name
Does this client meet the criteria for IOP level of care?
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Yes
No
Patient Name
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First Name
Last Name
Patient Date of Birth
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Month
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Day
Year
Date
Patient Phone Number
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Please enter a valid phone number.
Patient Email
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example@example.com
Patient Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Insurance Company
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Is this patient a current or former Ellie client?
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Yes
No
Submit
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