Skip to main content
Headway

Running a practice

What to include in a mental health referral form (with a template)

Mental health referral forms are a first step toward a client’s transition of care.

August 15, 2025

7 min read

Referring a client to another therapist can be a pivotal moment in their care, as well as your therapeutic relationship. Any transition requires flexibility and willingness to adjust, but in addition to a robust referral process, a mental health referral form template can serve as a helpful tool. These forms provide information on why a patient is seeking a new provider, giving clarity to their next therapist.

Practice in-network with confidence

Simplify insurance and save time on your entire workflow — from compliance and billing to credentialing and admin.

Talk to a practice consultant

Why effective mental health referral forms matter

As a therapist, you understand the importance of communication — and how communication gaps can harm your clients. A thoughtful referral process helps bridge those gaps, ensuring your client’s history, current needs, and risk factors are clearly communicated, received, and understood by the next clinician. Effective mental health referral forms are one piece of that.

Imagine a client transitioning to a new therapist who isn’t aware of their current medications due to an incomplete referral. Critical treatment details could be overlooked, making for an easily avoidable situation. A complete and detailed referral helps prevent these setbacks, supports the continuity of care, values your client’s well-being, and upholds your ethical responsibility as a clinician. 

Referrals go beyond simply submitting forms, however. While mental health referral forms help with collecting important information, your duty to the client has not ended once you’ve sent it. Once the referral is in motion, you will communicate additional information to support the transition of care.

An important distinction when it comes to psychotherapy notes

When referring a client to a new therapist, you’ll need to note certain clinical information in the mental health referral form for that provider to review. However, the information you provide cannot include psychotherapy notes, per the Privacy Rule. HIPAA requires an authorization to disclose psychotherapy notes, or in other words, information that is not included in the medical records of a patient. This means sharing psychotherapy notes requires a separate, specific HIPAA authorization signed by the client prior to disclosure. 

Psychotherapy notes are treated differently from other mental health information both because they contain particularly sensitive information and because they are the personal notes of the therapist that typically are not required or useful for treatment, payment, or healthcare operations purposes, other than by the mental health professional who created the notes.

The Privacy Rule defines psychotherapy notes as notes recorded by a health care provider who is a mental health professional documenting or analyzing the contents of a conversation during a private counseling session or a group, joint, or family counseling session and that are separate from the rest of the patient’s medical record. Psychotherapy notes do not include any information about medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, or results of clinical tests; nor do they include summaries of diagnosis, functional status, treatment plan, symptoms, prognosis, and progress to date. Psychotherapy notes also do not include any information that is maintained in a patient’s medical record.

Core components for mental health referral forms

While every form will highlight a clinician's unique style, language, and context, a strong mental health referral form template should include both clinical and logistical information. Afterward, the transfer of care process may also include sharing a detailed clinical assessment, treatment history, previous interventions, and more. This way, the receiving clinician is able to step into their role of providing care confidently, without requiring the client to tell their story from the beginning.

Client demographic and contact information

Accurate demographic information helps prevent administrative delays, ensures insurance coverage verification, and supports safety planning if crisis or concerns arise.

Here’s what to include:

  1. Full name and date of birth
  2. Sex at birth
  3. Gender identity
  4. Insurance provider and member ID (if applicable)
  5. Phone number
  6. Email
  7. Physical address
  8. Emergency contact details

Including this information may seem obvious, but it’s all quite necessary. Clearly stating the client's full name, date of birth, sex, gender identity, phone number, email, physical address, insurance details, and emergency contact is more than administrative — it lays the foundation for seamless and safe care coordination. Providing accurate, up-to-date information helps the new provider verify coverage and easily communicate with the client for scheduling or follow-ups. Most importantly, it ensures that if a crisis arises, emergency contacts are already documented and a physical address is accessible if needed. Prioritizing accurate information supports clinical safety and logistical efficiency while reducing unnecessary delays in care.

Reasons for referral

You’ll want to jot down a high-level overview of what the patient is seeking treatment for. Then, list out any presenting concerns and briefly touch on clinical observations, as well as the client’s treatment history and outcomes. You can note the types of therapy used, such as IFS, EMDR, CBT, group therapy, and more. 

And rather than using vague descriptions, opt for specific and objective language to help the receiving clinician quickly understand the client’s current needs and urgency. For example, instead of writing “client is anxious,” expand to include “client reports daily panic attacks triggered by overstimulating environments.” A more in-depth review of this information will happen once the transfer of care process begins.

Current medications and medical considerations

Document all active medications, including name, dosage, frequency, and the prescribing physician. Include relevant medical conditions (ex: chronic pain, neurological disorders, fertility treatments, metabolic conditions, etc. ) that could influence mental health treatment. 

Providing this information highlights the importance of medication reconciliation. This is a critical safety step that helps the receiving clinician identify potential interactions, ensure continuity of pharmacological care, and coordinate effectively with prescribers. 

Overall, thorough documentation reduces the risk of errors, helps maintain treatment stability during transitions, and equips the receiving clinician with the essential medical information needed to make informed clinical decisions.

Example mental health referral template

Client Information:

Name: _____________________________________

Date of birth (DOB): _____________________________________

Phone number: _____________________________________

Email: _____________________________________

Physical address: _____________________________________

Sex at birth: Male / Female

Gender identity: Male / Female / Non-Binary

Insurance provider and member ID: _____________________________________

Emergency contact: _____________________________________

Reason for referral:



Presenting concerns and clinical observations:



Treatment history and outcomes:



Current medications and medical notes:



Referring provider information

Name: _____________________________________

License #: _____________________________________

Contact: _____________________________________


Best practices for completing mental health referral forms

Now that you know what to include, understanding how to document a referral form can be the difference between a smooth and challenging transition for the client. Practical guidance includes:

  • Double-checking every detail with your client before sending to the receiving clinician to catch errors or updates — and ensuring your client has signed a Release of Information agreement, or ROI.
  • Avoiding vague descriptions or abbreviations the receiving clinician may be unaware of
  • Using clear, organized language and formatting so key details are not misunderstood

Keep in mind who the receiving clinician is and what they truly need to focus on to pick up care smoothly. Completing referral forms thoroughly helps everyone: your client, the receiving clinician, and yourself. Knowing that the client’s emotional experience is being prioritized allows the receiving clinician to show up without frustration — and allows you to terminate treatment in an ethical way. 

Ensuring clarity and specificity in your documentation

Specific, actionable language helps the receiving clinician clearly understand the client’s current needs. For example, rather than a broad statement like “client struggles with anxiety,” expanding it to “client reports difficulty sleeping more than four nights a week due to distressing thoughts” gives the receiving clinician a clearer picture. This level of detail helps the receiving clinician prioritize, plan, and seamlessly continue treatment without relying on the client to revisit or fill in those critical gaps.

Maintaining confidentiality and ethical considerations

Obtaining written consent from your client is essential before sharing any information with another provider. It’s customary to do this with a Release of Information agreement, or ROI. This process does not include the sharing of psychotherapy notes — or anything outside of the client’s medical record,  including the contents of conversations recorded during sessions — without prior authorization signed in writing.

When you do write to another provider (in accordance with HIPAA), include only what is clinically relevant to your client’s ongoing care, avoiding unnecessary details. Typically, you won’t include large amounts of PHI, or personal health information, on a referral form. 

HIPAA regulations and professional ethical guidelines highlight the importance of protecting client privacy while maintaining effective care coordination and continuity. Thoughtful, consent-supported documentation not only upholds trust and strengthens the therapeutic relationship but also helps ensure your practice remains both ethical and compliant.

Less admin, more connection

Headway helps therapists run in-network practices with tools that make forms, billing, and documentation less of a burden.

Talk to a practice consultant

This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.

© 2026 Therapymatch, Inc. dba Headway. All rights reserved. No part of this publication may be reproduced without permission.

Running a practice