
Referrals
Who can fill out a referral?
Any member of the community who has obtained consent from the person being referred can fill out the referral form. This includes but is not limited to:
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Pediatric offices
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OB/GYNs
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The Department of Children and Families (DCF)
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Social workers or mental health providers
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How should I fill out the referral form?
All required information is highlighted. Please make sure to include all information or we will not be able to properly process the referral.
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Special Cases:
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For infants: the infant's name, DOB, gender, address, and phone number should be included under "Client Information." And mother's information should be included in the "Parent/Guardian" section.
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If the child is not in the care of the mother, and you are referring the infant: the infant's name, DOB, gender, address, and phone number should be included under "Client Information." And guardian's information should be included in the "Parent/Guardian" section.
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If the child is not in the care of the mother, and you are referring the mother: the patient being referred would be marked as "mother without infant who is less than 18 months postpartum," and mother's information would be included in the client information.
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For incarcerated people: we are not able to contact anyone who is currently incarcerated.
How do I send in a referral?
Referrals should be faxed to (850) 696-2551. If you are unable to fax, please send the email to referrals@healthystart.info.