Richmond Referrals

Accepting CSA, Private Pay, Medicaid,

Anthem and Aetna

RITT is an outpatient therapy program that offers a wide range of current and creative therapeutic interventions. Treatment is tailored to address complex issues and help each child/person/family access their own unique and ever-present resources for healing.

Request for Service
Richmond Office
This form is confidential and goes to a secure email address

First and Last Name of Client

Age of Client:

Phone

Brief description of issue to be addressed

If the client a minor, are there any ongoing or upcoming court or custody issues? Is there any current or pending DSS involvement? If not applicable, please enter N/A

If this referral is for someone other than self please list your name and relationship to the client (Please note that we can only accept referrals from legal guardians. We cannot accept referrals on behalf of adult children, spouses, friends or family members.)

Please indicate your funding plan below:

Funding

Medicaid (we accept Aetna, Anthem Healthkeepers, Optima, and Molina/Magellan Complete Care)

Cash-Pay (income-based sliding scale options may be available)

CSA/FAPT

Anthem/BCBS Commercial

Aetna Commercial

Session Preference

Telehealth

In Person

Any special requests? (i.e. EMDR, a clinician that has children or is married, etc.)

Once your form has been submitted, the RITT Intake Coordinator will contact you. If you haven't received a response within 48 hours, please check your spam folder. The email will be coming from RITT Intake.

Please note that afterschool and evening appointments are rarely available. Your flexibility in scheduling is appreciated.

Riverbend Counseling Group │Riverbend Integrative Trauma Treatment

Accepting CSA, Private Pay, Medicaid,

Anthem and Aetna

Request for Service Richmond Office This form is confidential and goes to a secure email address

Please indicate your funding plan below:

Request for Service
Richmond Office
This form is confidential and goes to a secure email address