We are proud to partner with our area healthcare providers and nonprofit agencies to reduce barriers to mental health treatment. If you have a client in need of care, please complete the following Provider Request Form and Release of Information.

The Pastoral Institute is only able to provide counseling services to clients and agency participants. We do not offer psychiatry services and do not prescribe or monitor psychiatric medications for clients.

If you are interested in becoming a nonprofit agency placement to receive sponsored services as part of our Resident Clinical Training Program, please click here to complete the application.

Referral Request Form

Release of Information

*Please note we are unable to provide any information to your agency regarding your client’s appointments or treatment without the signed and witnessed Release of Information above. Please fax the completed form to (888) 863-0376.