Referral Options

Web-Based or Print and Send?

At Elements of Motivation, we attempt to be as paperless as possible--help us by using the e-Referral Form below. 

We will send you Electronic Consent forms to e-sign within 24 hours.

If you still prefer paper and pen, please see our referral form and consent forms below that can be downloaded and faxed to us at: (702) 446-8034 or emailed at

Thank you for trusting us to provide the best therapeutic services to you and yours!

Web-Based E-Referral