Referral Form
Use this form if you are referring to our Adolescent Mood & Anxiety Program or for any patient with counseling needs. You can fax this form to 850-270-6932 or email it to our office at office@blscounseling.net.
ED Referral Form
Use this form for referring patients with eating disorders. You can fax this form to 850-270-6932 or email it to our Intake Coordinator, Sancia, at sancia@blscounseling.net.
Our team at BLS has a collaborative spirit in efforts to help motivate and guide our clients as they embark on a journey to incorporate balance and wellness into their life. Thank you for allowing us the opportunity to cooperate with you to provide our clients with the best possible care. Be Well, Be Real, Be You
~ Danielle Shelton, CEDCAT, Founder & CEO of Better Living Solutions
It is helpful to send medical records with any referral, but we request them for all adolescents, medical nutrition, and eating disorders. Clients that are referred for eating disorders, please send growth charts (if adolescent) and order the following labs:
- Comprehensive Metabolic Panel (CMP)
- Prealbumin
- CBC (INCLUDES DIFF/PLT)
- Iron, TIBC Panel
- Ferritin
- Magnesium, RBC
- Phosphorus
- Vitamin B12/Folate, Panel
- Folate
- Vitamin D, 25-OH, Total, IA
- Hemoglobin A1c (HgbA1c)
- Lipid Panel, Standard (Includes Total Cholesterol)
- Thyroid Panel (TSH, T3, T4 & Reverse T3)
Our team works hard to create a collaborative and mutually beneficial environment for both clients and providers. If you need more information, please feel free to give our office a call at 850-765-6769 and ask for our Intake Coordinator, Sancia, or via email at sancia@blscounseling.net.