How to Refer

Professionals referring to our PMIC program are asked to fax or mail the following information to our Admissions Office:

Admissions staff are available for consultation. Those who seek more information or wish to make a referral are invited to contact an Admissions Coordinator to learn more about the program and, if appropriate, initiate a referral. In order to refer a child to Orchard Place, the Referral Application,  Bio/Psycho/Social Assessment and the Placement Agreement need to be completed by the parent or guardian. Campus tours are available. Admissions Coordinators can be contacted by phone or e-mail:

Talli Smith
Admissions Coordinator
(515) 287-9712
.(JavaScript must be enabled to view this email address)

Amy Stauffacher
Admissions Coordinator
(515) 287-9628
.(JavaScript must be enabled to view this email address)

Lori Dawson-Weeks
Director of Admissions
(515) 287-9615
.(JavaScript must be enabled to view this email address)

The Authorization for Release of Professional Information form must be completed for current and previous treatment or services providers and for all insurance and/or Medicaid. The form allows us to obtain records for the child and to contact insurance companies regarding benefits. Please complete one for each professional or agency who has worked with the child including the county DHS office (i.e. “Polk County DHS”) or Juvenile Court Office (i.e. “Warren County Juvenile Court”). They are considered the Health Care Provider and Orchard Place is the recipient. You may also sign a release at the office of the other treatment provider. Records can be faxed or mailed to us, please visit our contact page for details.