Refer Someone to Heart and Solutions

Thank you for referring to Heart and Solutions, LLC! We recognize that making a referral to mental and behavioral health care comes with careful consideration for all clients involved. Your confidence in our services means a great deal to us, and we’re committed to providing the best care possible.

Please note, this referral form will not automatically begin services.
 
If you complete this form, this system will automatically email the referred client or guardian a link to complete the referral form and intake packet.  This referral form and intake packet needs to be completed by the referred client or guardian to officially become a client of Heart and Solutions. 
 
One of our supervisors will also follow up via phone one time and will text the referred client or guardian the link to our referral form and intake packet to start services. 
 
Please ensure that the referred client or guardian is notified to check their email for this intake packet to officially sign up for services. 
 
If you prefer, you may print a pdf copy of our intake packet here to have the referred client or guardian complete it by hand.  
 
Once it is completed and signed, please submit that completed document via fax to 1-319-483-6661 or by email at [email protected]. 
 
A referral is not complete until the referred client or guardian completed the intake paperwork.
 

Referral FAQ

How does my referral complete the intake paperwork?
  • New clients and guardians of new clients complete the intake paperwork online at https://heartandsolutions.net/client-forms/referral-form/
  • Completing the outside referral form below sends and automated email to the client you are referring and let’s us know to keep an eye out for their paperwork. 
Can my referral complete the intake paperwork if they do not have a computer?
  • Yes!  Our referral form is mobile, tablet and computer friendly.  New clients can complete the intake form on a smartphone, tablet, or computer.
  • Our HIPAA compliant format allows new clients to complete the intake paperwork at a public library, a public computer, or the phone of a friend or family member without saving the information to the device.
Can my referral complete the intake paperwork if they do not have a computer?
  • We highly encourage referrals to independently complete the intake paperwork for both HIPAA compliance and to ensure they are fully prepared for our services. The individual completing the intake packet must be legally authorized to sign informed consent and releases of information on behalf of themselves or a client they have legal guardianship of.
How can I help my referral to complete the intake paperwork?
  • Complete the Referral Form on this page to send them a link to the intake packet.
  • Open the Get Started link on your device with the client or guardian present and let them complete the intake form on your device.
  • Text the intake form link to the client’s phone so that they can complete the intake paperwork from their phone.