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Submit Referrals

Referrals are needed before an appointment can be made. These referrals can be made by the person needing the appointment (self referral), friend, family member, and/or family services agency.

If you would like to make a referral, please download the Referral Form and fax to our Corporate office at (850) 769-6003. Your referral will be processed by the Referrals Coordinator and contact will be made within three (3) business days. If you have not heard from anyone at our agency, and would like to check the status of a referral, please contact us.

Download Referral Form

Referral Form

Want to check the status of your referral? Contact us:

Call or contact Lisa Riolo, Referrals Coordinator
Phone: (850) 769-6001
E-mail: referrals@flatherapy.com