Referral Package

Please download our current referral package click below:

Peak House Referral Package




In an attempt to reduce barriers at the intake process, we have revised the referral package.

  • The required package is now 8 pages in length. There are two optional pages for additional information.


  • The referral can be completed electronically in Adobe Acrobat by clicking the “fill and sign tab”.


  • The referral can be accessed through our website and faxed or emailed to us through our password protected form.


  • Use this password to access and send document pkhse 


Please ensure your referral package is current by downloading a new referral form. Old referral packages are no longer being accepted.