Medicaid Referral Form

Access the necessary documentation and secure submission portal for a seamless experience.

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Begin Now

Pathway to Health Counseling Services accepts Medicaid SSI, CareSource, Peach State, Amerigroup, and Coming Soon: United Healthcare, Molina Healthcare, and Humana. 

Please fill out the appropriate form (adult or child) and submit it to us and we will be in touch with you within 48 hours.

We proudly provide all DFCS-related services, and we are here to guide you through the service authorization process. All DFCS cases are assigned a therapist, parent aide, specimen collector, psychiatrist, psychologist, or behavior aide within 24 hours.

How to Submit a Referral

Once you download and complete the appropriate form:

Fax it to: (866) 484-8285

Or email a scanned copy to: contactus@pathwaytohopecounseling.com

A team member will respond to your inquiry within 24 hours. If you don’t see the form you need, please contact us—our friendly staff is always ready to assist. 229-249-7730.

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Download Medicaid Referral Forms

Medicaid Referral – Child
Medicaid Referral – Adult

We will process your referral form within 48 hours. You will receive a thank you notice and you will be informed which therapist is assigned to perform the comprehensive assessment and individualized treatment plan.