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Refer a Patient to Cortica

To refer a patient to us, please complete the form below. Our team will follow up with the family directly or will contact you by phone or email with any questions. We look forward to caring for your patients.


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You did it! Congratulations on taking this important step for your family’s future :)
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See Cortica Locations

If you are a parent interested in starting services at Cortica for your child, please click here.

Prefer to fax us instead of filling out this form? To refer a patient, please fax Cortica’s enrollment team at (888) 417-4189.

It’s an unbelievable dream that J. has blossomed in this way. We didn’t know he knew so much. Now we can communicate. He’s so proud that he can demonstrate what he knows. 
J. & J., Parents of a young adult with Autism Spectrum Disorder