Referral
Contact us
support@thewellms.org
PHONE NUMBER
662-368-2008
LOCATION
617 18th Ave N. Columbus, MS 39701
Instructions for Referring Agencies
Thank you for partnering with The Well: Family Support. You may submit referrals by either requesting a specific appointment or submitting a referral for our office to schedule using the buttons below.
General Information (Applies to Both Options)
Select “Someone else” when asked who will be receiving care.
Enter your name and contact information (or the referring provider’s information).
Use the “How can we help?” field to include referral details.
Required fields are marked with a red asterisk (*); all others are optional.
Referrals for Minor Clients
Select Yes for “Is the client a minor?”
Enter the minor’s name and date of birth.
Only include the minor’s email or phone number if parent/guardian consent has been provided.
List the guardian’s name, email, and phone number in the guardian section
(do not enter guardian information as the minor’s contact details).
What Happens Next
Our office will be notified and will email intake documents to the client or guardian using the email address provided. Please advise them to watch for an email from YourProvider or The Well. Emails may occasionally be filtered to spam or junk folders.
Questions?
If you need assistance with the referral process, please contact our office. We value collaboration and appreciate your partnership.
Meaningful care is built through collaboration. We’re honored to partner with you.
