Become a Trusted Edify Referral Partner
Share your organization details so our partnerships team can send your referral packet and set up a direct referral line.
Organization name
*
Organization type
*
Please Select
Physician / primary care practice
Hospital or health system
Psychiatric or behavioral health provider
School, college, or university
Church or ministry
Law firm / attorney
Employer / HR / EAP
Military or veteran organization
Coach, trainer, or wellness provider
Community or nonprofit organization
Other
Contact full name
*
First Name
Last Name
Title / role
*
Work email
*
example@example.com
Direct phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Organization website
City / county served
*
Estimated referrals per month
1-2
3-5
6-10
10+
Not sure yet
Services you expect to refer for
Individual therapy (adults)
Teens and children
Couples and marriage
Family therapy
Psychiatric evaluation and medication management
Psychological evaluations
Trauma recovery
Men's mental health
Military and veteran services
Faith-based / Christian counseling
Temperament assessment
Telehealth
Insurance your clients most often carry
Preferred way to receive referral updates
Email
Phone
Fax
Secure portal
Best time to connect
How did you hear about Edify?
Please Select
Edify team member called or visited
Colleague referral
Website or search
Social media
Event
Other
Anything else we should know
Send me the Edify Professional Referral Guide.
*
Yes, send me the guide
Request Partnership
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