Referral

Emergency Assistance

If this is an emergency, call:

Crisis Line: (800) 981-4357
911

Referrer Information

First name

Last name

Email address

Phone number

Relationship to client

Is the client aware of this referral?

Yes

Please proceed with the client's information

We cannot process the referral without the client's consent. Please reach out to the client first.

Client Information

First name

Last name

Email address

Phone number

Is the client looking for a therapist who specializes in working with Asian/Asian-American?

Yes No

Does your client prefer a therapist who can understand one of the following languages? Current available languages

No preference

Cantonese

Mandarin

Korean

Thai

Insurance Policy Number

Date of birth (For insurance verification)

Reasons for your referral

Your information will be encrypted.

Elephant In The Room Counseling

Founded by a group of compassionate Asian American Clinical Social Workers, Elephant in the Room Counseling recognizes the limit of behavioral health services in Asian communities and strives to help fill that gap. Equipped with strong clinical skills and cultural/linguistic expertise, we are dedicated to empowering and improving access to behavioral health for individuals from underserved communities while acknowledging and embracing cultural differences.

(617) 657-3381‬
www.elephantroomcounseling.com
440 Hancock St, Quincy, Massachusetts, 02171, United States