Psychology

• DCH patient referral form (Script signed by PCP and must have ICD 10 codes)
• Patient must be referred by Primary Care Physician
• Insurance/Medicaid Card (Front & Back)
• Demographic Information
• Physician’s notes/diagnosis
• Please note: two or more complex Dx required for patient referral.
• Referral age is toddler to 12 years old.
• The only Medicaid insurance accepted are Driscoll Health Plan and TMHP Medicaid. All other private insurance is Out of Network.
• All services are only for short term.

For suspected but not yet diagnosed referral for Autism, please send screening results for Autism. Exp. - (MCHAT)