Expedited referral form for PHP
Thank you for considering a referral to Rogers Behavioral Health. To make the intake and admission process as smooth as possible for you and your patient, please provide the following information on this secure form. This referral will be handled in a way that respects your patient’s privacy and complies with HIPAA regulations.
A Rogers representative will let you know we received your referral and will follow up with you.
If you do not have information for a required field, please enter "unknown".