Make a Referral | Clarity Wellness Behavioral Health Center

Why Reach Out?

Your First Step Toward Healing

Whether you're a community member seeking help for yourself, a family member advocating for a loved one, or a professional referring a client — this form is your starting point. We respond promptly and treat every referral with care.

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Phone (440) 730-1194

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Email info@claritywellnessbh.com

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Address 3100 E. 45th St., Suite 510B
Cleveland, OH 44127

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Office Hours Monday – Friday: 9:00 AM – 5:00 PM

🛡️ Confidential & HIPAA-Compliant.
All referral information is protected. We will never share your information without written authorization.

Insurance Accepted

Ohio Medicaid CareSource Molina Buckeye Health UnitedHealthcare Community Plan Paramount Self-Pay / Sliding Scale

Referral & Intake Request

Complete all fields below. We'll contact you within 1 business day.

Who Is This Referral For?

I am submitting this referral as:

Client Information

Client First Name *

Client Last Name *

Date of Birth *

Client Phone *

Client Address

Insurance / Coverage *

Reason for Referral

Primary Presenting Concern(s) *

Services Requested

Additional Notes or Urgency

Your Contact Information

Your Name *

Your Phone *

Your Email *

Best Time to Reach You

I consent to being contacted by Clarity Wellness Behavioral Health Center regarding this referral. *

* Required fields. Your information is confidential and HIPAA-protected. Submitting opens your email client to send directly to our intake team.

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Referral Submitted!

Thank you. Our intake team will reach out within 1 business day. If this is a crisis, please call or text 988 immediately.