DBT Program Referral Form

Please complete the following form to refer a client to our Dialectical Behavioral Therapy (DBT) program. After this form is submitted, our DBT Treatment Team will meet to discuss the referral and set up a DBT intake assessment appointment. If your client is accepted, we will contact you to discuss consultation.
Please keep in mind that DBT is contraindicated for individuals with antisocial personality disorder or narcissistic personality disorder.

If you have any questions, please contact Mood Treatment Center for more information.
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Clients Preferred Method of Contact