Referrals | Serenity Springs Counseling and Wellness

Refer A Patient to Serenity Springs

The following form is secured through encryption and is HIPAA compliant. Please contact us with any questions.

By completing the following form, you are authorizing a referral to the providers at Serenity Springs Counseling & Wellness. Please provide complete information so that we can best serve our mutual patient. In lieu of completing some fields you may attach your own referral form. If you include a reference number, we can report back to you that we have received your referral and whether the patient follows through on setting up an appointment. Please contact us with any questions and have a great day!

IMPORTANT! Before checking “Would Like Serenity Springs To Contact Them”, please confirm that the patient has agreed for us to call them.

We are located in the historic Teacherage building at the corners of Academy and Ennis Streets in Fuquay-Varina.

Phone: 919.753.1275
Note: Our phone system is secure and HIPAA compliant so your privacy is assured when leaving us a message.
Email: Contact Us

Referring Office
Referring Clinician
Referring Office Email
Please make sure your email address is accurate so that our response is not delayed.
Reference Number

This patient: Will Contact Serenity Springs Would Like Serenity Springs To Contact Them

Patient's First Name
Patient's Last Name

Patient's Insurance:

Patient's Phone
Patient's Diagnosis

Reason for referral:
Add files:
(This may be used to upload Intake forms if you already have a confirmed appointment)

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