How to Submit a Referral for Consultation
External Providers
To request consult services through the Hub, please have the patient/family complete the Mental Health Background Form, PSC-17 screener, ROI & Consent, and include the most relevant clinical note indicative of the reason for referral.
- a completed electronic referral packet may be submitted online at UF Behavioral Health Hub – REDCap
- a completed printable referral packet may be faxed to 850-308-7299
If any additional screeners were administered please include them; the Hub may also request other screeners.
UF Providers
If you are referring within UF Health, please utilize REF929 in Epic when submitting an order for consultative services.
Pensacola Forms
- Hub Fax Cover Sheet
- Mental Health Background Form
- Mental Health Background Form-Cover Letter
- Patient Consent and Authorization
- Patient Release of Information
- PCP Needs Assessment
- Provider Data Sheet
- Referral Packet
- Referral-Staffing Form
- Roadmap – English
- Roadmap – Spanish
- Satisfaction Survey – Patient/Parent
- Satisfaction Survey – Physician
- Satisfaction Survey – Young Adult
- What to Expect – for Patients/Families
