Screening Request

If this is an emergency, please call 9-1-1 immediately or go to the nearest emergency room.

Request a free screening to see if Rogers can help. We’ll assess your needs and an intake specialist will call you back as soon as possible to schedule a telephone screening. Please know we will respect your privacy and comply with HIPAA regulations throughout the process. Healthcare providers can submit a provider referral to refer a patient.

Where are you seeking treatment? Required

This screening is for Required

Your name—if screening is not for you

This screening is about Required

How old are you/is this person? Required

Name Required

Email Required

Phone Required

Voice Message Required

City Required

State Required

Postal Code/ZIP Code Required

By submitting this screening request, you can expect a call from the Rogers team to schedule a complete telephone screening that will help to determine if there is a Rogers program appropriate for you.

Screening Request

By submitting this screening request, you can expect a call from the Rogers team to schedule a complete telephone screening that will help to determine if there is a Rogers program appropriate for you.

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