{"id":2747,"date":"2025-04-07T14:06:53","date_gmt":"2025-04-07T14:06:53","guid":{"rendered":"https:\/\/heahearetreat.com\/?page_id=2747"},"modified":"2025-04-09T16:23:21","modified_gmt":"2025-04-09T16:23:21","slug":"refer-a-client","status":"publish","type":"page","link":"https:\/\/heahearetreat.com\/index.php\/refer-a-client\/","title":{"rendered":"Refer a Client"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2747\" class=\"elementor elementor-2747\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-77e27a10 elementor-section-content-middle elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-equal-height-no\" data-id=\"77e27a10\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-7ca6ecc4 elementor-invisible\" data-id=\"7ca6ecc4\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;animation&quot;:&quot;fadeInLeft&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-77ae2f59 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-equal-height-no\" data-id=\"77ae2f59\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-1cb09dcb\" data-id=\"1cb09dcb\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-75c4e02d elementor-widget elementor-widget-heading\" data-id=\"75c4e02d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Refer a Client to HeaHea \u2013 Healing Starts Today\n\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-374d44fc elementor-widget elementor-widget-text-editor\" data-id=\"374d44fc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"\" data-start=\"1054\" data-end=\"1214\"><code data-start=\"1099\" data-end=\"1214\">We specialize in holistic care for youth facing eating disorders, disordered eating, and trauma-related symptoms.<\/code><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2c4f0bd3 elementor-widget elementor-widget-button\" data-id=\"2c4f0bd3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"#referral-form\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Make a Referral Now<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-379fec80 elementor-invisible\" data-id=\"379fec80\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;animation&quot;:&quot;fadeInRight&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7dab7c25 eael-infobox-icon-bg-shape-square eael-infobox-icon-hover-bg-shape-none elementor-widget elementor-widget-eael-info-box\" data-id=\"7dab7c25\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"eael-info-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"eael-infobox icon-on-left\">\n\t            <div class=\"infobox-icon eael-icon-only\">\n\n            \n                            <div class=\"infobox-icon-wrap\">\n                    <i aria-hidden=\"true\" class=\"material-icons md-healing\"><\/i>                <\/div>\n            \n            \n        <\/div>\n            <div class=\"infobox-content eael-icon-only\">\n                    <div class=\"infobox-title-section\">\n                <h2 class=\"title\">PHP with academic support<\/h2>            <\/div>\n                    <\/div>\n            <\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3538b585 eael-infobox-icon-bg-shape-square eael-infobox-icon-hover-bg-shape-none elementor-widget elementor-widget-eael-info-box\" data-id=\"3538b585\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"eael-info-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"eael-infobox icon-on-left\">\n\t            <div class=\"infobox-icon eael-icon-only\">\n\n            \n                            <div class=\"infobox-icon-wrap\">\n                    <i aria-hidden=\"true\" class=\"xlio ion-md-happy\"><\/i>                <\/div>\n            \n            \n        <\/div>\n            <div class=\"infobox-content eael-icon-only\">\n                    <div class=\"infobox-title-section\">\n                <h2 class=\"title\">Optional boarding<\/h2>            <\/div>\n                    <\/div>\n            <\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7af2d558 eael-infobox-icon-bg-shape-square eael-infobox-icon-hover-bg-shape-none elementor-widget elementor-widget-eael-info-box\" data-id=\"7af2d558\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"eael-info-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"eael-infobox icon-on-left\">\n\t            <div class=\"infobox-icon eael-icon-only\">\n\n            \n                            <div class=\"infobox-icon-wrap\">\n                    <i aria-hidden=\"true\" class=\"fas fa-brain\"><\/i>                <\/div>\n            \n            \n        <\/div>\n            <div class=\"infobox-content eael-icon-only\">\n                    <div class=\"infobox-title-section\">\n                <h2 class=\"title\">Trauma-informed, whole-person care<\/h2>            <\/div>\n                    <\/div>\n            <\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-60cc67d eael-infobox-icon-bg-shape-square eael-infobox-icon-hover-bg-shape-none elementor-widget elementor-widget-eael-info-box\" data-id=\"60cc67d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"eael-info-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"eael-infobox icon-on-left\">\n\t            <div class=\"infobox-icon eael-icon-only\">\n\n            \n                            <div class=\"infobox-icon-wrap\">\n                    <i aria-hidden=\"true\" class=\"fas fa-stopwatch\"><\/i>                <\/div>\n            \n            \n        <\/div>\n            <div class=\"infobox-content eael-icon-only\">\n                    <div class=\"infobox-title-section\">\n                <h2 class=\"title\">Fast intake process<\/h2>            <\/div>\n                    <\/div>\n            <\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5bc584e eael-infobox-icon-bg-shape-square eael-infobox-icon-hover-bg-shape-none elementor-widget elementor-widget-eael-info-box\" data-id=\"5bc584e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"eael-info-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"eael-infobox icon-on-left\">\n\t            <div class=\"infobox-icon eael-icon-only\">\n\n            \n                            <div class=\"infobox-icon-wrap\">\n                    <i aria-hidden=\"true\" class=\"far fa-id-card\"><\/i>                <\/div>\n            \n            \n        <\/div>\n            <div class=\"infobox-content eael-icon-only\">\n                    <div class=\"infobox-title-section\">\n                <h2 class=\"title\">Accepts Fedelis, Aetna, MVP, Carelon (Pending: BCBS, Cigna)<\/h2>            <\/div>\n                    <\/div>\n            <\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-a8b4f2e elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-equal-height-no\" data-id=\"a8b4f2e\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-ad8d490\" data-id=\"ad8d490\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-58a819d elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-equal-height-no elementor-invisible\" data-id=\"58a819d\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;animation&quot;:&quot;fadeInUp&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-832d9c3\" data-id=\"832d9c3\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-dfc9760 elementor-widget elementor-widget-heading\" data-id=\"dfc9760\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">HeaHea\u2019s Referral Form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8b8a75a elementor-widget elementor-widget-heading\" data-id=\"8b8a75a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Fill up the form below <\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-f7e89dd eael-fluentform-form-button-custom elementor-invisible elementor-widget elementor-widget-eael-fluentform\" data-id=\"f7e89dd\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"referral-form\" data-settings=\"{&quot;_animation&quot;:&quot;fadeInUp&quot;}\" data-widget_type=\"eael-fluentform.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"eael-contact-form eael-fluent-form-wrapper clearfix placeholder-hide eael-contact-form-align-default\">\n\n            \n            <div class='fluentform ff-default fluentform_wrapper_3 ffs_default_wrap'><form data-form_id=\"3\" id=\"fluentform_3\" class=\"frm-fluent-form fluent_form_3 ff-el-form-top ff_form_instance_3_1 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_3_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">HeaHea Referral Form<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='2747' \/><input type=\"hidden\" id=\"_fluentform_3_fluentformnonce\" name=\"_fluentform_3_fluentformnonce\" value=\"fff9087d0a\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/2747\" \/><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_1\" ><h3>\ud83e\uddd1 Referrer Info Section<\/h3><\/div><div class='ff-el-group ff-el-form-right'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text' id='label_ff_3_input_text' aria-label=\"Title\/Organization\">Title\/Organization<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" data-name=\"input_text\" id=\"ff_3_input_text\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div data-type=\"name-element\" data-name=\"names_1\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-right'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_names_1_first_name_' id='label_ff_3_names_1_first_name_' >Full Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_1[first_name]\" id=\"ff_3_names_1_first_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group ff-el-form-right'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_email_1' id='label_ff_3_email_1' aria-label=\"Email\">Email<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email_1\" id=\"ff_3_email_1\" class=\"ff-el-form-control\" placeholder=\"Email Address\" data-name=\"email_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group ff-el-form-right'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_numeric-field' id='label_ff_3_numeric-field' aria-label=\"Phone\">Phone<\/label><\/div><div class='ff-el-input--content'><input type=\"number\" name=\"numeric-field\" id=\"ff_3_numeric-field\" class=\"ff-el-form-control\" data-name=\"numeric-field\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_2\" ><h3>\ud83d\udc64 Client Info Section<\/h3><\/div><div class='ff-el-group ff-el-form-right'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text_1' id='label_ff_3_input_text_1' aria-label=\"Full Name\">Full Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" data-name=\"input_text_1\" id=\"ff_3_input_text_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group ff-el-form-right'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text_14' id='label_ff_3_input_text_14' aria-label=\"Age\">Age<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_14\" class=\"ff-el-form-control\" data-name=\"input_text_14\" id=\"ff_3_input_text_14\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group ff-el-form-right'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text_2' id='label_ff_3_input_text_2' aria-label=\"Gender Identity (optional)\">Gender Identity (optional)<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_2\" class=\"ff-el-form-control\" data-name=\"input_text_2\" id=\"ff_3_input_text_2\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group ff-el-form-right'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text_5' id='label_ff_3_input_text_5' aria-label=\"City\/State\">City\/State<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_5\" class=\"ff-el-form-control\" data-name=\"input_text_5\" id=\"ff_3_input_text_5\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_3\" ><h3>\ud83d\udc64 Parent\/Guardian Info Section<\/h3><\/div><div data-name=\"ff_cn_id_2\"  class='ff-t-container ff-column-container ff_columns_total_3 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text_6' id='label_ff_3_input_text_6' aria-label=\"Parent\/Guardian Name\">Parent\/Guardian Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_6\" class=\"ff-el-form-control\" data-name=\"input_text_6\" id=\"ff_3_input_text_6\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_numeric-field_1' id='label_ff_3_numeric-field_1' aria-label=\"Contact Info\">Contact Info<\/label><\/div><div class='ff-el-input--content'><input type=\"number\" name=\"numeric-field_1\" id=\"ff_3_numeric-field_1\" class=\"ff-el-form-control\" data-name=\"numeric-field_1\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text_4' id='label_ff_3_input_text_4' aria-label=\"Preferred Contact Method\">Preferred Contact Method<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_4\" class=\"ff-el-form-control\" data-name=\"input_text_4\" id=\"ff_3_input_text_4\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_4\" ><h3>\ud83e\udde0 Clinical Overview Section<\/h3><\/div><div data-name=\"ff_cn_id_3\"  class='ff-t-container ff-column-container ff_columns_total_4 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text_8' id='label_ff_3_input_text_8' aria-label=\"Primary Concerns\">Primary Concerns<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_8\" class=\"ff-el-form-control\" data-name=\"input_text_8\" id=\"ff_3_input_text_8\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text_9' id='label_ff_3_input_text_9' aria-label=\"Brief Description of Symptoms\">Brief Description of Symptoms<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_9\" class=\"ff-el-form-control\" data-name=\"input_text_9\" id=\"ff_3_input_text_9\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text_10' id='label_ff_3_input_text_10' aria-label=\"Prior Treatment (optional)\">Prior Treatment (optional)<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_10\" class=\"ff-el-form-control\" data-name=\"input_text_10\" id=\"ff_3_input_text_10\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-4' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text_11' id='label_ff_3_input_text_11' aria-label=\"School (optional)\">School (optional)<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_11\" class=\"ff-el-form-control\" data-name=\"input_text_11\" id=\"ff_3_input_text_11\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_5\" ><h3>\ud83c\udfe5 Insurance Section<\/h3><\/div><div class='ff-el-group ff-el-form-right'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_dropdown' id='label_ff_3_dropdown' aria-label=\"Select\">Select<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown\" id=\"ff_3_dropdown\" class=\"ff-el-form-control\" data-name=\"dropdown\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_3_dropdown\"><option value=\"\">- options -<\/option><option value=\"Fidelis Care\"  >Fidelis Care<\/option><option value=\"Excellus\"  >Excellus<\/option><option value=\"MVP\"  >MVP<\/option><option value=\"Aetna\"  >Aetna<\/option><option value=\"Carlon\"  >Carlon<\/option><option value=\"others\"  >others<\/option><\/select><\/div><\/div><div class='ff-el-group ff-el-form-right'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text_12' id='label_ff_3_input_text_12' aria-label=\"Member ID\">Member ID<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_12\" class=\"ff-el-form-control\" data-name=\"input_text_12\" id=\"ff_3_input_text_12\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_6\" ><h3>\ud83d\udcdd Additional Notes<\/h3><\/div><div class='ff-el-group'><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_3_description\" name=\"description\" id=\"ff_3_description\" class=\"ff-el-form-control\" rows=\"4\" cols=\"2\" data-name=\"description\" ><\/textarea><\/div><\/div><div data-name=\"ff_cn_id_4\"  class='ff-t-container ff-column-container ff_columns_total_1 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_7\" ><h5><em>\u26a0 <\/em>HeaHea respects your privacy. Any personal information you submit will be kept confidential and used solely to respond to your inquiry, in accordance with our Privacy Policy and HIPAA guidelines.<\/h5><\/div><\/div><\/div><div class='ff-el-group ff-text-left ff_submit_btn_wrapper'><button type=\"submit\" class=\"ff-btn ff-btn-submit ff-btn-lg ff_btn_style\"  aria-label=\"Submit\">Submit<\/button><\/div><\/fieldset><\/form><div id='fluentform_3_errors' class='ff-errors-in-stack ff_form_instance_3_1 ff-form-loading_errors ff_form_instance_3_1_errors'><\/div><\/div>            <script type=\"text\/javascript\">\n                window.fluent_form_ff_form_instance_3_1 = {\"id\":\"3\",\"settings\":{\"layout\":{\"labelPlacement\":\"top\",\"helpMessagePlacement\":\"with_label\",\"errorMessagePlacement\":\"inline\"},\"restrictions\":{\"denyEmptySubmission\":{\"enabled\":false}}},\"form_instance\":\"ff_form_instance_3_1\",\"form_id_selector\":\"fluentform_3\",\"rules\":{\"input_text\":{\"required\":{\"value\":true,\"message\":\"This field is required\"}},\"names_1[first_name]\":{\"required\":{\"value\":true,\"message\":\"This field is required\"}},\"names_1[middle_name]\":{\"required\":{\"value\":false,\"message\":\"This field is required\"}},\"names_1[last_name]\":{\"required\":{\"value\":false,\"message\":\"This field is required\"}},\"email_1\":{\"required\":{\"value\":true,\"message\":\"This field is required\"},\"email\":{\"value\":true,\"message\":\"This field must contain a valid email\"}},\"numeric-field\":{\"required\":{\"value\":true,\"message\":\"This field is required\"},\"numeric\":{\"value\":true,\"message\":\"This field must contain numeric value\"},\"min\":{\"value\":\"\",\"message\":\"Minimum value is \"},\"max\":{\"value\":\"\",\"message\":\"Maximum value is \"},\"digits\":{\"value\":\"\",\"message\":\"The number of digits has to be \"}},\"input_text_1\":{\"required\":{\"value\":true,\"message\":\"This field is required\"}},\"input_text_14\":{\"required\":{\"value\":true,\"message\":\"This field is required\"}},\"input_text_2\":{\"required\":{\"value\":false,\"message\":\"This field is required\"}},\"input_text_5\":{\"required\":{\"value\":true,\"message\":\"This field is required\"}},\"input_text_6\":{\"required\":{\"value\":true,\"message\":\"This field is required\"}},\"numeric-field_1\":{\"required\":{\"value\":true,\"message\":\"This field is required\"},\"numeric\":{\"value\":true,\"message\":\"This field must contain numeric value\"},\"min\":{\"value\":\"\",\"message\":\"Minimum value is \"},\"max\":{\"value\":\"\",\"message\":\"Maximum value is \"},\"digits\":{\"value\":\"\",\"message\":\"The number of digits has to be \"}},\"input_text_4\":{\"required\":{\"value\":true,\"message\":\"This field is required\"}},\"input_text_8\":{\"required\":{\"value\":true,\"message\":\"This field is required\"}},\"input_text_9\":{\"required\":{\"value\":true,\"message\":\"This field is required\"}},\"input_text_10\":{\"required\":{\"value\":false,\"message\":\"This field is required\"}},\"input_text_11\":{\"required\":{\"value\":false,\"message\":\"This field is required\"}},\"dropdown\":{\"required\":{\"value\":true,\"message\":\"This field is required\"}},\"input_text_12\":{\"required\":{\"value\":true,\"message\":\"This field is required\"}},\"description\":{\"required\":{\"value\":false,\"message\":\"This field is required\"}}},\"debounce_time\":300};\n                            <\/script>\n                    <\/div>\n\n        \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Refer a Client to HeaHea \u2013 Healing Starts Today We specialize in holistic care for youth facing eating disorders, disordered eating, and trauma-related symptoms. Make a Referral Now PHP with academic support Optional boarding Trauma-informed, whole-person care Fast intake process Accepts Fedelis, Aetna, MVP, Carelon (Pending: BCBS, Cigna) HeaHea\u2019s Referral Form Fill up the form below HeaHea Referral Form \ud83e\uddd1 Referrer Info Section Age Full Name Email Phone \ud83d\udc64 Client Info Section Full Name City\/State Gender Identity (optional) City\/State \ud83d\udc64 Parent\/Guardian Info Section Parent\/Guardian Name Contact Info Preferred Contact Method \ud83e\udde0 Clinical Overview Section Primary Concerns Brief Description of Symptoms Prior Treatment (optional) School (optional) \ud83c\udfe5 Insurance Section Select &#8211; options &#8211;FedelisAetnaMVPCarelonOthersCarrier (Others) Member ID \ud83d\udcdd Additional Notes Submit Your opinion<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"_eb_attr":"","om_disable_all_campaigns":false,"footnotes":""},"class_list":["post-2747","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/heahearetreat.com\/index.php\/wp-json\/wp\/v2\/pages\/2747","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/heahearetreat.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/heahearetreat.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/heahearetreat.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/heahearetreat.com\/index.php\/wp-json\/wp\/v2\/comments?post=2747"}],"version-history":[{"count":21,"href":"https:\/\/heahearetreat.com\/index.php\/wp-json\/wp\/v2\/pages\/2747\/revisions"}],"predecessor-version":[{"id":2790,"href":"https:\/\/heahearetreat.com\/index.php\/wp-json\/wp\/v2\/pages\/2747\/revisions\/2790"}],"wp:attachment":[{"href":"https:\/\/heahearetreat.com\/index.php\/wp-json\/wp\/v2\/media?parent=2747"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}