Mental Health Academy

Young Israel Aish, as part of its mental health program, assists in providing referrals.

For a referral, please fill out the form below.

All information will be kept strictly confidential.

*Young Israel Aish does not guarantee the success of any treatment, nor do we ensure that you will be a good match with the therapist to whom you are referred. We continue to improve our referrals by getting feedback from people like you.

I am a mental health professional.
I would like to be added to Young Israel Aish’s referral list:

Name

Phone

Your credentials (for example, “LMFT”):

What are your specialties (for example, “trauma, ADHD,”):

Do you accept insurance / which ones?

What are your self-pay rates? Would you consider offering a sliding scale?

Best times to contact you to discuss further:

I am a mental health professional.
I would like to be added to Young Israel Aish’s referral list:

Upcoming Programs

Past Programs

Title

I am a mental health professional. I would like to be added to Young Israel Aish’s referral list:

Upcoming Programs

Past Programs

Title

I am a mental health professional.
I would like to be added to Young Israel Aish’s referral list: