We are committed to providing the highest quality of service to all of our clients, including those who have been referred to us for

Workers' Compensation matters. In order to maintain an orderly and efficient process,

we kindly ask that you please follow the guidelines outlined below when referring clients to us:

• Before completing the Intake form, please inform us if there are any associated medical records with the referral. If so, kindly provide an estimate of the total number of pages or the physical size of the records in inches. Please note that we may need to limit cases with voluminous medical records to ensure an efficient process.

• Please ensure that all necessary documents and information are provided in a timely manner. This includes the following document(s): a) Intake form and FROI.

• Upon receipt of the completed intake form, we will promptly prepare MindHope Letter of Guaranty- Fee Agreement and invoice, which will be sent to the Adjuster for review and signature. [Please be aware that when the referral is for Psychiatric Evaluation and Treatment, all proceedings will be handled through the Adjuster, who holds the authority to approve or deny the treatment].

• If you are referring a client to us, please complete the intake form below and provide the FROI. It is important that the form is fully completed and all required information is provided, as any missing or incomplete information may cause delays in the referral process. Additionally, we kindly request that you read our Welcome Letter and review our office General/Financial Policies, which are exclusively for the referring party.

• Prepayment is required two weeks prior to the scheduled Initial Evaluation. If the prepayment is not received by the due date indicated on the Invoice, the appointment will be canceled. Please note that the Invoice includes the client's appointment date and time.

• Please advise your client to Visit our website at www.mindhopehealth.com in order to complete the new patient forms diligently. We kindly request that they bring the completed forms with them to their scheduled appointment.

• Inform your client to please arrive 15-20 minutes early for their appointment.

Should you have any inquiries or apprehensions, please feel free to reach out to us without hesitation. Our team is dedicated to providing support and assistance in any manner possible. We extend our gratitude for your cooperation and for your valuable contribution to helping us deliver the utmost quality of service to our esteemed clients.