Submit a referralinfo@pivotpointcounseling.org(614) 696-7312(614) 696-7772 (fax)90 Northwoods Blvd Suite BColumbus, OH 43235 Patient Name * First Name Last Name Patient Date of Birth * MM DD YYYY Parent/Guardian Phone * (###) ### #### Parent/Guardian Email Preferred Clinician * Lynsey Pearson, MSEd, LPCC-S Sarah Sparhawk, MSEd, LPCC Kathleen Cruse-Grasser, MS, LPCC-S No Preference Contact referring provider or patient? * Referring Provider Patient Referring Provider Name * First Name Last Name Referring Provider Email Referring Provider Phone (###) ### #### Reason for Referral * Thank you for your referral. A team member will be in touch within 1-3 business days.
