Admissions & Referrals | Prolific Counseling Group

How it works

Making a referral

Call our Admissions and Intake team on 757-937-8929, or use the form below to request a call back. A member of the team will contact you on a secure line to take the clinical details.

Please have the following ready for that call:

Current medical history or physical exam
Current medications, type and dosage
Insurance or Medicaid information
Social history and any legal involvement
Summary of prior treatment and level of care
Your contact information and best time to reach you

Admissions & Intake

Referral line: 757-937-8929
Intake email: prolificintakes757@gmail.com
Fax: 757-257-6800
After hours & urgent: 757-405-4201
Clinical contact: Deshay Edwards, LCSW-S
757-658-9850

Do not send protected health information through this website. Completed DMAS referral forms must be faxed or delivered securely — never emailed or submitted through this site.

Step one

Download the DMAS referral form

Community Stabilization referrals use the Virginia Department of Medical Assistance Services Community Stabilization (S9482) Referral Form. Our provider details are already filled in — you complete the member and referring provider sections, sign the attestation, and return it to us.

DMAS Community Stabilization (S9482) Referral Form

Microsoft Word · 165 KB · Provider section pre-filled

Download form

Returning the completed form

The form contains protected health information and carries your signed attestation, so it must come back to us by a secure route:

Fax — 757-257-6800 (preferred)
Secure electronic transfer from your organization’s system — call us to arrange
Hand delivery to 865 Monticello Avenue, Norfolk

Please do not email the completed form

Ordinary email is not a secure channel for member names, dates of birth, or Medicaid numbers. Fax it, or call Intake on 757-937-8929 and we will arrange a secure transfer.

Questions before you refer?

Use the form below to ask us anything or request a call back. It collects your contact details only — please keep member information off it.

Request a call from Intake

We respond during business hours. To speak to Intake now, call 757-937-8929. For an urgent placement outside business hours, call 757-405-4201 rather than using this form.

About you

Your name *

Your title or role

Referring organization *

Phone *

Email *

Best time to reach you

About the referral

Tell us what service you are seeking and how quickly. Do not include the client’s name, date of birth, diagnosis, or any other health information — we will take all of that by phone.

Service requested *

Urgency *

Preferred location

How did you hear about us?

Anything else we should know? Logistics and scheduling only — no client health information.

I understand that this form is not secure, and I have not included any protected health information. *

We respond during business hours. For an emergency, call 911.

This is a design preview. The form validates correctly but is not connected to anything yet — nothing was sent or stored. Wiring it up to deliver to Intake is the next build step.