≪ Client Referral Form
Pasadena Villa Outpatient
Refer a Client to Pasadena Villa Outpatient
Thank you for trusting Pasadena Villa Outpatient with your client’s care. To begin the referral process, please complete the secure online form below. This helps ensure we have the clinical and logistical details needed to streamline the admissions experience.
After You Submit
An admissions coordinator will promptly reach out to your client to guide them through the next steps.
If you’d prefer that we connect with you first, simply note this in the Reason for Referral field.
Submitting Clinical Records
To support a smooth transition, we welcome relevant documentation, including:
Client fact sheet
Insurance information
Current clinical evaluation
Three most recent progress notes
Medication list
Discharge plan (if applicable)
Please send records via fax to 424.416.7238 or email admissions. Our goal is to collaborate with referring professionals to deliver timely, personalized care that supports long-term healing.