Referral Contact

Client Information


Name of person referring client:

Medical History

Psych History and Current Symptoms


Current Medications

PARC staff will review the referred and get back to you within three business days. If you have any questions or concerns, please call (317) 880- 8494


Department of Psychiatry | 1111 W. 10th Street, PB A212 | Indianapolis, IN | 46202 | (317) 274-1224