Refer a patient for residential care

Thank you for referring to Rogers Behavioral Health. To make the admission process as smooth as possible, please provide the following information on this secure form. Please be assured that this referral will be handled in a way that respects your patient’s privacy and complies with HIPAA regulations. You may also make a referral by calling 800-767-4411.

We will reach out directly to your client/patient to schedule a screening. If you would like to discuss this referral, please contact your outreach representative. For a complete listing click here.

Have new contact information to share? Please update your credentials and practice information here.

Patient name *

If patient is under 18, parent or guardian name: *

Patient phone number: *

Patient email: *

If patient or family will need interpreter services, please indicate preferred language:

Referral Provider Name: *

Seeking services for: *

Select the location nearest you: *

Programming differs by location. For a complete list of program offerings by location, visit our program directory.

Provider phone number: *

Provider email: *

Your state: *

Relationship with patient:

Based on this referral, please be aware that Rogers will reach out directly to your patient. Please check this box to approve. *

Yes

Notes:

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Rising Above Borderline Personality Disorders | Briden's Story

Briden struggled with low self-esteem and self-harm. When she entered high school, she says her mental health started to spiral resulting in an ... Read More

Refer a patient for residential care

Rising Above Borderline Personality Disorders | Briden's Story

Call 800-767-4411 or go to rogersbh.org to request a free screening.