Kindbridge Behavioral Health Referral Form
A streamlined referral process for clinics, healthcare providers, and partner organizations.
Use this secure form to refer a client to Kindbridge Behavioral Health for evaluation and treatment. Once submitted, our engagement team will reach out to the client (or their guardian) within 1–2 business days to begin screening and schedule appropriate services. With client consent, we’ll keep you informed to support coordinated, continuous care.
Referral Form
Thank you for completing the Problem Gambling Assessment.
Answering ‘yes’ to one of the questions indicates that, currently, you are at increased risk for developing or experiencing gambling-related problems. You are not alone. About 1% of adults and 5% of college students report they have experienced a severe gambling-related problem during their lifetime. Gambling-related problems can take a variety of forms, including money problems, relationship problems, health problems, school problems, and more.
*Disclaimer: These Problem Gambling Assessment results do not represent a clinical diagnosis.
Thank you for completing the Problem Gambling Assessment.
Your responses do not indicate symptoms consistent with Problem Gambling. Enhance your mental well-being and overall health by arranging your initial session
*Disclaimer: These Problem Gambling Assessment results do not represent a clinical diagnosis.