Upcoming Free Workshop: Making Space for Grief — Saturday, Oct 24, 2026 | Register Now
Partner With Emerging Hearts

Therapy Referral Form

We welcome referrals from physicians, psychiatrists, healthcare organizations, churches, universities, schools, and community partners across North Carolina. Self-referrals and family referrals are also gladly accepted.

All submitted information is handled with strict confidentiality. Once received, our clinical team will reach out to the client within 1 to 2 business days.

1. Referral Source Information

(If you are referring yourself or a loved one, you may enter "Self-Referral" below.)

2. Client Information

3. Services Requested (Select All That Apply)

4. Primary Concerns & Reason for Referral

5. Insurance & Payment Preference

Free Community Workshop

Making Space for Grief: Preparing for the Holidays

Join us for a free community workshop focused on practical tools for navigating grief, holiday triggers, boundaries, and the emotions that can surface during the season.

Saturday, Oct 24, 2026
10:00 AM–11:30 AM
Fayetteville, NC

Doors open at 9:30 AM. Location: Beyond Blue Neighborhood Center, 1800 Owen Dr, Fayetteville, NC 28304. Admission is free, but registration is required and seating is limited.

We respect your privacy. You will only receive updates regarding this October gathering.