Refer a Client for Targeted Case Management

Complete this form to refer someone for Mental Health Targeted Case Management (MH-TCM) services. We serve adults with SPMI and children with SED in Stearns, Benton, Sherburne, Hennepin, and Ramsey counties.

No referral required — self-referrals accepted. A Diagnostic Assessment completed within the last 180 days is required to enroll.

1 — Referring Party

2 — Client Information

3 — Insurance & Coverage

4 — Areas of Concern

Check all that apply.

5 — Safety Assessment

Referrals with active risk flags are prioritized for same-day intake contact.

6 — Additional Information

This form is not monitored 24/7. If this is a psychiatric emergency, call 988 or 911. We respond to all referrals within one business day.