---
title: Primary Care to Integrated Behavioral Health Referral Form Template | Paperform
description: Professional referral form for primary care providers to connect patients with integrated behavioral health services. Supports same-day access, warm handoffs, and collaborative care coordination.
url: "https://paperform.co/templates/primary-care-to-integrated-behavioral-health-referral-form"
type: static
generatedAt: "2026-03-28T00:44:53.148Z"
---

[← Back to free form templates](/templates/)    ![Primary Care to Integrated Behavioral Health Referral Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/primary-care-to-integrated-behavioral-health-referral-form.png)
    [Preview](https://_preview.paperform.co/ai-template/primary-care-to-integrated-behavioral-health-referral-form) [Use this template for free](/create?ai-template=primary-care-to-integrated-behavioral-health-referral-form)    [Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/)[Mental Health](/templates/industry/mental-health/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Therapist](/templates/role/therapist/)[Counselor](/templates/role/counselor/)[Social Worker](/templates/role/social-worker/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
### Streamline Primary Care to Behavioral Health Referrals with Paperform

In integrated care settings, timely and accurate behavioral health referrals can make all the difference in patient outcomes. This **Primary Care to Integrated Behavioral Health Referral Form** is designed specifically for healthcare practices implementing collaborative care models with co-located mental health services.

Whether you're a primary care physician, nurse practitioner, or care coordinator, this template helps you quickly refer patients for same-day mental health access, facilitate warm handoffs to therapists, and maintain seamless communication between providers.

#### Why This Template Works for Collaborative Care

This referral form captures all essential clinical information—from presenting concerns and PHQ-9/GAD-7 screening scores to medication history and risk assessments—in a structured, HIPAA-aware format. It supports the collaborative care model by documenting referral urgency, preferred intervention types, and care coordination needs, ensuring behavioral health providers have everything they need for immediate assessment.

The form includes sections for patient demographics, insurance verification, clinical presentation, current treatments, and specific referral requests, making it ideal for practices offering integrated behavioral health, primary care behavioral health (PCBH) models, or co-located mental health services.

#### Automate Your Referral Workflow with Stepper

Connect this form to [Stepper](https://stepper.io) to automate your entire referral process. Automatically route urgent referrals to behavioral health specialists, send confirmation notifications to both referring and receiving providers, update your EHR system, schedule follow-up appointments, and track referral completion rates—all without manual data entry.

Paperform's conditional logic ensures you only collect relevant information based on referral type and urgency level, while calculation fields can automatically score screening assessments. With over 3,000 integrations available, you can connect this form to your practice management system, scheduling software, or secure messaging platform.

**Trusted by healthcare providers nationwide**, this template helps medical practices, community health centers, behavioral health clinics, and integrated care teams deliver faster, more coordinated mental health support when patients need it most.
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