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Outpatient Plus

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YHS Referral Form
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- REFERRAL SOURCE
  
  AGENCY NAME REQUIRED Please fill out this field. Please enter valid data.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- PLEASE CHECK (BELOW) YOUR PREFERRED LOCATION REQUIRED Rockingham County Office Stokes County Office Guilford County Office Caswell County Office Please fill out this field.
- Name of Person for Whom Services are Requested
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Guardian's Name
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Guardian's Contact Information (email, phone, etc.) REQUIRED Please fill out this field. Please enter valid data.
- Why are you seeking services? REQUIRED Please fill out this field.
- Primary Insurance REQUIRED Please fill out this field. Please enter valid data.
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Outpatient Plus is a "step up" from outpatient therapy services in that it adds the component of Case Management. This truly helps the client and family with whole person care and helps them navigate all the systems they often find themselves lost in (schools, DJJ, DSS, primary care, etc.).

OPT Plus consists of an LP/therapist and a QP/case manager who work together on a caseload of approximately 20 clients/families. OPT Plus is a level of care between OPT and IIH/MST. This service can be offered through a combination of virtual and in person service delivery depending on the family’s needs.