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Families Educators & Referral Partners
For Referral Partners

Refer a client to our team.

We know coordinating care across providers takes trust. Share the details below and our clinical team will take it from here.

For Referral Partners

Submit a Referral

Thank you for considering CPC for your client. Please complete the referral form below and our clinical team will follow up within two business days to confirm receipt and discuss next steps.

For urgent referrals or to discuss a client before submitting a formal referral, please contact us directly by phone or email.

(302) 707-4981 · info@cpclinicians.com

Referring Provider Information
Preferred Contact Method
Client Information
Reason for ReferralSelect all that apply.
Has the client received a previous diagnosis?
Service Preference
Insurance & Authorization
Is Prior Authorization Required?
Is Family Aware of This Referral?
Additional Information
This referral form is intended for use by licensed healthcare providers, educators, and authorized professionals only. Please limit clinical information to what is necessary for referral coordination. Submission of this form does not guarantee acceptance of the referral or establishment of a clinician-client relationship.

Prefer to submit by fax or email? Contact us for a printable referral form →

Thank you for your referral.

Our clinical team will review the information you’ve provided and follow up within two business days to confirm receipt and discuss next steps. We appreciate your trust in CPC.

Other Ways to Reach Us

Prefer to Reach Out Directly?

Phone

(302) 707-4981
Monday – Friday
9:00 AM – 6:00 PM ET

Email

info@cpclinicians.com
We respond within
two business days

Location

Delaware &
surrounding states
In-person & telehealth

There’s No Wrong Way to Start

Reach out however feels right.

If you’re not sure which form to use, or you just want to ask a quick question before committing to anything — that’s completely okay. Send us a message and we’ll point you in the right direction.

“We’ll take it from there.”