{"id":3272,"date":"2025-12-27T07:09:50","date_gmt":"2025-12-27T04:09:50","guid":{"rendered":"https:\/\/fshncounseling.org\/medical-professional-referral\/"},"modified":"2026-03-18T23:29:13","modified_gmt":"2026-03-18T20:29:13","slug":"medical-professional-referral","status":"publish","type":"page","link":"https:\/\/fshncounseling.org\/ar\/medical-professional-referral\/","title":{"rendered":"\u0625\u062d\u0627\u0644\u0629 \u0645\u0646 \u0623\u062e\u0635\u0627\u0626\u064a \u0637\u0628\u064a"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1365px;margin-left: calc(-5% \/ 2 );margin-right: calc(-5% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:2.375%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:2.375%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:2.375%;--awb-spacing-left-medium:2.375%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:2.375%;--awb-spacing-left-small:2.375%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-1 fusion-sep-none fusion-title-text fusion-title-size-one\" style=\"--awb-text-color:var(--awb-color5);\"><h1 class=\"fusion-title-heading title-heading-right\" style=\"margin:0;\">\u0625\u062d\u0627\u0644\u0629 \u0645\u0646 \u0623\u062e\u0635\u0627\u0626\u064a \u0637\u0628\u064a<\/h1><\/div><div class=\"fusion-text fusion-text-1\"><p>\u0635\u064f\u0645\u0645 \u0646\u0645\u0648\u0630\u062c \u0627\u0644\u0625\u062d\u0627\u0644\u0629 \u0647\u0630\u0627 \u0644\u062a\u0633\u0647\u064a\u0644 \u0627\u0644\u062a\u0648\u0627\u0635\u0644 \u0627\u0644\u0622\u0645\u0646 \u0648\u0627\u0644\u0645\u0647\u0646\u064a \u0628\u064a\u0646 \u0645\u0642\u062f\u0645\u064a \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629 \u0644\u0625\u062d\u0627\u0644\u0629 \u0627\u0644\u0645\u0631\u0636\u0649 \u0625\u0644\u0649 \u062e\u062f\u0645\u0627\u062a \u0627\u0644\u0627\u0633\u062a\u0634\u0627\u0631\u0629 \u0641\u064a \u0634\u0628\u0643\u0629 \u0627\u0644\u0635\u062d\u0629 \u0627\u0644\u0623\u0633\u0631\u064a\u0629. \u062a\u064f\u0639\u0627\u0645\u0644 \u062c\u0645\u064a\u0639 \u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0627\u0644\u0645\u064f\u0642\u062f\u0645\u0629 \u0628\u0633\u0631\u064a\u0629 \u062a\u0627\u0645\u0629\u060c \u0648\u064a\u0631\u0627\u062c\u0639\u0647\u0627 \u0627\u0644\u0641\u0631\u064a\u0642 \u0627\u0644\u0637\u0628\u064a \u0627\u0644\u0645\u062e\u062a\u0635 \u0644\u0636\u0645\u0627\u0646 \u0631\u0639\u0627\u064a\u0629 \u0622\u0645\u0646\u0629 \u0648\u0645\u0646\u0633\u0642\u0629 \u0648\u0645\u062a\u0645\u062d\u0648\u0631\u0629 \u062d\u0648\u0644 \u0627\u0644\u0645\u0631\u064a\u0636. <\/p>\n<\/div><div class=\"fusion-text fusion-text-2\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-3543 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-3543\" data-uid=\"69d4e29bf2a78\"><br\/><\/div><form\r\n\t\t\t\tid=\"forminator-module-3543\"\r\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-3543 forminator-design--default  forminator_ajax\"\r\n\t\t\t\tmethod=\"post\"\r\n\t\t\t\tdata-forminator-render=\"0\"\r\n\t\t\t\tdata-form-id=\"3543\"\r\n\t\t\t\tenctype=\"multipart\/form-data\" data-color-option=\"default\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\r\n\t\t\t\tdata-uid=\"69d4e29bf2a78\"\r\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"group-1\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Referring Healthcare Professional Information<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_69d4e29bf2a78\" id=\"forminator-field-name-1_69d4e29bf2a78-label\" class=\"forminator-label\">Full Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"\" id=\"forminator-field-name-1_69d4e29bf2a78\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-3\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-3_69d4e29bf2a78\" id=\"forminator-field-name-3_69d4e29bf2a78-label\" class=\"forminator-label\">Specialty <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-3\" value=\"\" placeholder=\"\" id=\"forminator-field-name-3_69d4e29bf2a78\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-4\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-4_69d4e29bf2a78\" id=\"forminator-field-name-4_69d4e29bf2a78-label\" class=\"forminator-label\">Clinic \/ Hospital Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-4\" value=\"\" placeholder=\"\" id=\"forminator-field-name-4_69d4e29bf2a78\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"Email\" id=\"forminator-field-email-1_69d4e29bf2a78\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"Phone\" id=\"forminator-field-phone-1_69d4e29bf2a78\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Add item\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Remove item\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-2\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Patient Information<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"name-7\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-7_69d4e29bf2a78\" id=\"forminator-field-name-7_69d4e29bf2a78-label\" class=\"forminator-label\">Patient Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-7\" value=\"\" placeholder=\"\" id=\"forminator-field-name-7_69d4e29bf2a78\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-1\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-1_69d4e29bf2a78\" id=\"forminator-field-number-1_69d4e29bf2a78-label\" class=\"forminator-label\">Age <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-1\" value=\"\" placeholder=\"\" id=\"forminator-field-number-1_69d4e29bf2a78\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-3543__field--select-2_69d4e29bf2a78\" id=\"forminator-form-3543__field--select-2_69d4e29bf2a78-label\" class=\"forminator-label\">Gender <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-3543__field--select-2_69d4e29bf2a78\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-2\" data-default-value=\"\" data-placeholder=\"Gender\" data-search=\"false\" data-search-placeholder=\"Gender\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-3543__field--select-2_69d4e29bf2a78-label\"><option value=\"\"  >Gender<\/option><option value=\"Male\"  data-calculation=\"0\">Male<\/option><option value=\"Female\"  data-calculation=\"0\">Female<\/option><option value=\"I&#039;d-Rather-Not-Disclose\"  data-calculation=\"0\">I'd Rather Not Disclose<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_69d4e29bf2a78\" id=\"forminator-field-textarea-1_69d4e29bf2a78-label\" class=\"forminator-label\">Clinical \/ Referral Information <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_69d4e29bf2a78\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Add item\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Remove item\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-3\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Referral Details<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-69d4e29bf2a78-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-69d4e29bf2a78-label\" class=\"forminator-label\">Services Requested <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-1-1-69d4e29bf2a78-label\" for=\"forminator-field-checkbox-1-1-69d4e29bf2a78\" class=\"forminator-checkbox\" title=\"Applied Behavior Analysis (ABA)\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Male\" id=\"forminator-field-checkbox-1-1-69d4e29bf2a78\" aria-labelledby=\"forminator-field-checkbox-1-1-69d4e29bf2a78-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Applied Behavior Analysis (ABA)<\/span><\/label><label id=\"forminator-field-checkbox-1-2-69d4e29bf2a78-label\" for=\"forminator-field-checkbox-1-2-69d4e29bf2a78\" class=\"forminator-checkbox\" title=\"Psychology\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Female\" id=\"forminator-field-checkbox-1-2-69d4e29bf2a78\" aria-labelledby=\"forminator-field-checkbox-1-2-69d4e29bf2a78-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Psychology<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_69d4e29bf2a78\" id=\"forminator-field-textarea-2_69d4e29bf2a78-label\" class=\"forminator-label\">Additional Notes for the Clinical Team<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_69d4e29bf2a78\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-6 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-69d4e29bf2a78-label\"><span id=\"forminator-radiogroup-radio-1-69d4e29bf2a78-label\" class=\"forminator-label\">Recent Surgery or Injury?<\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-69d4e29bf2a78\" class=\"forminator-radio\" title=\"yes\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-69d4e29bf2a78\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">yes<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-69d4e29bf2a78\" class=\"forminator-radio\" title=\"no\"><input type=\"radio\" name=\"radio-1\" value=\"two\" id=\"forminator-field-radio-1-2-69d4e29bf2a78\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">no<\/span><\/label><\/div><\/div><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-6 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-69d4e29bf2a78-label\"><span id=\"forminator-radiogroup-radio-2-69d4e29bf2a78-label\" class=\"forminator-label\">Urgency Level<\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-69d4e29bf2a78\" class=\"forminator-radio\" title=\"Routine\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-69d4e29bf2a78\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Routine<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-69d4e29bf2a78\" class=\"forminator-radio\" title=\"Priority\"><input type=\"radio\" name=\"radio-2\" value=\"two\" id=\"forminator-field-radio-2-2-69d4e29bf2a78\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Priority<\/span><\/label><label id=\"forminator-field-radio-2-label-3\" for=\"forminator-field-radio-2-3-69d4e29bf2a78\" class=\"forminator-radio\" title=\"Urgent\"><input type=\"radio\" name=\"radio-2\" value=\"Urgent\" id=\"forminator-field-radio-2-3-69d4e29bf2a78\" aria-labelledby=\"forminator-field-radio-2-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Urgent<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-1\" class=\"forminator-field-upload forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-1_69d4e29bf2a78\" id=\"forminator-field-upload-1_69d4e29bf2a78-label\" class=\"forminator-label\">Attachments<\/label><div class=\"forminator-multi-upload \" data-element=\"upload-1_69d4e29bf2a78\" aria-describedby=\"forminator-field-upload-1_69d4e29bf2a78-description\"><input type=\"file\" name=\"upload-1[]\" id=\"forminator-field-upload-1_69d4e29bf2a78\" class=\"forminator-input-file forminator-field-upload-1_69d4e29bf2a78-3543\" multiple=\"multiple\" data-method=\"ajax\" data-size=\"8000000\" data-size-message=\"Maximum file size allowed is 8 MB. \"><div class=\"forminator-multi-upload-message\" aria-hidden=\"true\"><span class=\"forminator-icon-upload\" aria-hidden=\"true\"><\/span><p>Drag and Drop (or) <a class=\"forminator-upload-file--forminator-field-upload-1_69d4e29bf2a78\" href=\"#\" onclick=\"return false;\">Choose Files<\/a><\/p><\/div><\/div><span id=\"forminator-field-upload-1_69d4e29bf2a78-description\" class=\"forminator-description\">Upload referral letter \/ reports (PDF, JPG)<\/span><ul class=\"forminator-uploaded-files upload-container-upload-1_69d4e29bf2a78\"><\/ul><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Add item\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Remove item\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-1\" class=\"forminator-field-consent forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-consent-1_69d4e29bf2a78\" id=\"forminator-field-consent-1_69d4e29bf2a78-label\" class=\"forminator-label\">Consent <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-1_69d4e29bf2a78__label\" class=\"forminator-checkbox forminator-consent\" aria-labelledby=\"forminator-field-consent-1_69d4e29bf2a78-label\"><input type=\"checkbox\" name=\"consent-1\" id=\"forminator-field-consent-1_69d4e29bf2a78\" value=\"checked\" aria-labelledby=\"forminator-field-consent-1_69d4e29bf2a78-label\" aria-describedby=\"forminator-field-consent-1_69d4e29bf2a78__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-1_69d4e29bf2a78__description\" class=\"forminator-checkbox__label forminator-consent__label\"><p data-end=\"3948\" data-start=\"3833\"><strong>I confirm that I am a licensed medical professional and that patient consent has been obtained for this referral.<\/strong><\/p><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Submit Referral Securely<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"5394214926\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/ar\/wp-json\/wp\/v2\/pages\/3272\" \/><input type=\"hidden\" name=\"form_id\" value=\"3543\"><input type=\"hidden\" name=\"page_id\" value=\"3272\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/fshncounseling.org\/ar\/medical-professional-referral\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"forminator-multifile-hidden\" class=\"forminator-multifile-hidden\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form>\n<\/div><div class=\"fusion-title title fusion-title-2 fusion-sep-none fusion-title-text fusion-title-size-four\" style=\"--awb-text-color:var(--awb-color5);\"><h4 class=\"fusion-title-heading title-heading-right\" style=\"margin:0;\"><a href=\"https:\/\/fshncounseling.org\/ar\/privacy-and-confidentiality\/\" class=\"awb-custom-text-color awb-custom-text-hover-color\" target=\"_self\">\u0627\u0644\u0645\u0648\u0627\u0641\u0642\u0629 \u0648\u0627\u0644\u0633\u0631\u064a\u0629<\/a><\/h4><\/div><\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-3272","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>\u0625\u062d\u0627\u0644\u0629 \u0645\u0646 \u0623\u062e\u0635\u0627\u0626\u064a \u0637\u0628\u064a - FSHN Counseling<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/fshncounseling.org\/ar\/medical-professional-referral\/\" \/>\n<meta property=\"og:locale\" content=\"ar_AR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u0625\u062d\u0627\u0644\u0629 \u0645\u0646 \u0623\u062e\u0635\u0627\u0626\u064a \u0637\u0628\u064a - FSHN Counseling\" \/>\n<meta property=\"og:url\" content=\"https:\/\/fshncounseling.org\/ar\/medical-professional-referral\/\" \/>\n<meta property=\"og:site_name\" content=\"FSHN Counseling\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/fshn.counseling\" \/>\n<meta property=\"article:modified_time\" content=\"2026-03-18T20:29:13+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/fshncounseling.org\/wp-content\/uploads\/2026\/03\/coun-1200-675.png\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"675\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"\u0648\u0642\u062a \u0627\u0644\u0642\u0631\u0627\u0621\u0629 \u0627\u0644\u0645\u064f\u0642\u062f\u0651\u0631\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 \u062f\u0642\u064a\u0642\u0629\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":[\"WebPage\",\"MedicalWebPage\"],\"@id\":\"https:\/\/fshncounseling.org\/ar\/medical-professional-referral\/\",\"url\":\"https:\/\/fshncounseling.org\/ar\/medical-professional-referral\/\",\"name\":\"\u0625\u062d\u0627\u0644\u0629 \u0645\u0646 \u0623\u062e\u0635\u0627\u0626\u064a \u0637\u0628\u064a - FSHN Counseling\",\"isPartOf\":{\"@id\":\"https:\/\/fshncounseling.org\/ar\/#website\"},\"datePublished\":\"2025-12-27T04:09:50+00:00\",\"dateModified\":\"2026-03-18T20:29:13+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/fshncounseling.org\/ar\/medical-professional-referral\/#breadcrumb\"},\"inLanguage\":\"ar\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/fshncounseling.org\/ar\/medical-professional-referral\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/fshncounseling.org\/ar\/medical-professional-referral\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/fshncounseling.org\/ar\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"\u0625\u062d\u0627\u0644\u0629 \u0645\u0646 \u0623\u062e\u0635\u0627\u0626\u064a \u0637\u0628\u064a\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/fshncounseling.org\/ar\/#website\",\"url\":\"https:\/\/fshncounseling.org\/ar\/\",\"name\":\"FSHN Counseling\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\/\/fshncounseling.org\/ar\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/fshncounseling.org\/ar\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"ar\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/fshncounseling.org\/ar\/#organization\",\"name\":\"FSHN Counseling\",\"alternateName\":\"Fawzia Sultan Healthcare Network - Counseling\",\"url\":\"https:\/\/fshncounseling.org\/ar\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"ar\",\"@id\":\"https:\/\/fshncounseling.org\/ar\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/fshncounseling.org\/wp-content\/uploads\/2026\/03\/Counseling-696.png\",\"contentUrl\":\"https:\/\/fshncounseling.org\/wp-content\/uploads\/2026\/03\/Counseling-696.png\",\"width\":696,\"height\":696,\"caption\":\"FSHN Counseling\"},\"image\":{\"@id\":\"https:\/\/fshncounseling.org\/ar\/#\/schema\/logo\/image\/\"},\"sameAs\":[\"https:\/\/www.facebook.com\/fshn.counseling\",\"https:\/\/www.instagram.com\/FSHN.counseling\",\"https:\/\/www.linkedin.com\/company\/fawzia-sultan-healthcare-network\",\"https:\/\/www.tiktok.com\/@fshn.counseling\",\"https:\/\/www.youtube.com\/channel\/UCHy1k_0hdmGnBU76hWT5y8A\"]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"\u0625\u062d\u0627\u0644\u0629 \u0645\u0646 \u0623\u062e\u0635\u0627\u0626\u064a \u0637\u0628\u064a - FSHN Counseling","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/fshncounseling.org\/ar\/medical-professional-referral\/","og_locale":"ar_AR","og_type":"article","og_title":"\u0625\u062d\u0627\u0644\u0629 \u0645\u0646 \u0623\u062e\u0635\u0627\u0626\u064a \u0637\u0628\u064a - FSHN Counseling","og_url":"https:\/\/fshncounseling.org\/ar\/medical-professional-referral\/","og_site_name":"FSHN Counseling","article_publisher":"https:\/\/www.facebook.com\/fshn.counseling","article_modified_time":"2026-03-18T20:29:13+00:00","og_image":[{"width":1200,"height":675,"url":"https:\/\/fshncounseling.org\/wp-content\/uploads\/2026\/03\/coun-1200-675.png","type":"image\/png"}],"twitter_card":"summary_large_image","twitter_misc":{"\u0648\u0642\u062a \u0627\u0644\u0642\u0631\u0627\u0621\u0629 \u0627\u0644\u0645\u064f\u0642\u062f\u0651\u0631":"1 \u062f\u0642\u064a\u0642\u0629"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":["WebPage","MedicalWebPage"],"@id":"https:\/\/fshncounseling.org\/ar\/medical-professional-referral\/","url":"https:\/\/fshncounseling.org\/ar\/medical-professional-referral\/","name":"\u0625\u062d\u0627\u0644\u0629 \u0645\u0646 \u0623\u062e\u0635\u0627\u0626\u064a \u0637\u0628\u064a - FSHN Counseling","isPartOf":{"@id":"https:\/\/fshncounseling.org\/ar\/#website"},"datePublished":"2025-12-27T04:09:50+00:00","dateModified":"2026-03-18T20:29:13+00:00","breadcrumb":{"@id":"https:\/\/fshncounseling.org\/ar\/medical-professional-referral\/#breadcrumb"},"inLanguage":"ar","potentialAction":[{"@type":"ReadAction","target":["https:\/\/fshncounseling.org\/ar\/medical-professional-referral\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/fshncounseling.org\/ar\/medical-professional-referral\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/fshncounseling.org\/ar\/"},{"@type":"ListItem","position":2,"name":"\u0625\u062d\u0627\u0644\u0629 \u0645\u0646 \u0623\u062e\u0635\u0627\u0626\u064a \u0637\u0628\u064a"}]},{"@type":"WebSite","@id":"https:\/\/fshncounseling.org\/ar\/#website","url":"https:\/\/fshncounseling.org\/ar\/","name":"FSHN Counseling","description":"","publisher":{"@id":"https:\/\/fshncounseling.org\/ar\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/fshncounseling.org\/ar\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"ar"},{"@type":"Organization","@id":"https:\/\/fshncounseling.org\/ar\/#organization","name":"FSHN Counseling","alternateName":"Fawzia Sultan Healthcare Network - Counseling","url":"https:\/\/fshncounseling.org\/ar\/","logo":{"@type":"ImageObject","inLanguage":"ar","@id":"https:\/\/fshncounseling.org\/ar\/#\/schema\/logo\/image\/","url":"https:\/\/fshncounseling.org\/wp-content\/uploads\/2026\/03\/Counseling-696.png","contentUrl":"https:\/\/fshncounseling.org\/wp-content\/uploads\/2026\/03\/Counseling-696.png","width":696,"height":696,"caption":"FSHN Counseling"},"image":{"@id":"https:\/\/fshncounseling.org\/ar\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/fshn.counseling","https:\/\/www.instagram.com\/FSHN.counseling","https:\/\/www.linkedin.com\/company\/fawzia-sultan-healthcare-network","https:\/\/www.tiktok.com\/@fshn.counseling","https:\/\/www.youtube.com\/channel\/UCHy1k_0hdmGnBU76hWT5y8A"]}]}},"_links":{"self":[{"href":"https:\/\/fshncounseling.org\/ar\/wp-json\/wp\/v2\/pages\/3272","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/fshncounseling.org\/ar\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/fshncounseling.org\/ar\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/fshncounseling.org\/ar\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/fshncounseling.org\/ar\/wp-json\/wp\/v2\/comments?post=3272"}],"version-history":[{"count":7,"href":"https:\/\/fshncounseling.org\/ar\/wp-json\/wp\/v2\/pages\/3272\/revisions"}],"predecessor-version":[{"id":3711,"href":"https:\/\/fshncounseling.org\/ar\/wp-json\/wp\/v2\/pages\/3272\/revisions\/3711"}],"wp:attachment":[{"href":"https:\/\/fshncounseling.org\/ar\/wp-json\/wp\/v2\/media?parent=3272"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}