Northshore Counseling Center

Referrals

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Many clients are referred to us by another satisfied client or physicians in our area. Recommendations have allowed us to build a business family unique in terms of character, responsibility, and awareness.

So if you have friends, relatives, or patients who would be interested in our services, just use the form below to let us know who they are. We're sure they would appreciate your recommendation and so would we.

I want to refer a friend:

Your information:
Full name:
Email address:
Telephone number:
Can we use your name?
Yes
No
Your friend's information:
Full name:
Email address:
Telephone number:
Comments: