Harvest Of Hope
Terms & Conditions
PLEASE READ THE FOLLOWING CUSTOMER REFERRAL PROGRAM TERMS AND CONDITIONS CAREFULLY BEFORE PARTICIPATING IN THE CUSTOMER REFERRAL PROGRAM. PARTICIPATION IN THIS PROGRAM CONSTITUTES YOUR ACCEPTANCES OF ALL THE PROGRAM TERMS AND CONDITIONS.
(MUST BE A LICENSED MENTAL HEALTH PROVIDER) Verbal Approval from Therapist to refer identified consumer for Psychiatric Rehabilitation services secured. I am authorized or have been given authorization to give consent for Harvest of Hope Behavioral Health PRP to collaborate with service providers to receive and verify the information on this form for screening assessment purposes, and to determine the appropriateness of services for above-referenced individual.
We are excited that you are choosing to participate in Harvest of Hope Behavioral Health participant referral program. Your participation in the program is strictly subject to the program terms and Harvest of Hope terms. If you have any questions please feel free to contact us at any time.