How to Submit a Referral for Consultation
External Providers
To request consult services through the Hub, a complete referral packet must be faxed to 850-308-7299. Please score the PSC-17 screener, and include the most relevant clinical note indicative of the reason for referral. 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
- Satisfaction Survey – Patient/Parent
- Satisfaction Survey – Physician
- Satisfaction Survey – Young Adult