Referral Form – Adult Psychiatric Rehabilitation Program (PRP)


The Adult Psychiatric Rehabilitation Program (PRP) provides adults with structured individual and group sessions, designed to develop and enhance independent living skills and the management of mental illness symptoms.

Please fill in all the form fields as accurately as possible. If there is missing or incomplete information, it may cause a delay in processing your referral information.

You have two options to submit a referral to us.

  • It can be printed, completed and faxed to 410-220-0730.  ATTN: Ms. Wise

Click Here to Print

  • Fill in the form to the right and submit it through our secure website

For questions about completing this form or inquiries about our services please call 410-617-8026  x 0 or email and a program representative will reply within 1 business day.