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 (To see the full listing of services offered at each location, visit the program directory or the appropriate location page. Not every service below is offered at each location.) Required

How old are you/is this person? Required

Patient name Required

Email Required

Phone Required

Voice Message Required

City Required

State Required

Postal Code/ZIP Code Required

How did you hear about Rogers? Check all that apply.

Internet search or social media

Professional referral

Word of mouth, personal referral, or general reputation

Community event or conference

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.

It is always our goal to respond in a timely manner, but due to an extremely high volume of requests, it may take longer than normal to respond. If your need is urgent, it is best to call us at 800-767-4411.

Denise's Story

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Screening Request

It is always our goal to respond in a timely manner, but due to an extremely high volume of requests, it may take longer than normal to respond. If your need is urgent, it is best to call us at 800-767-4411.

Denise's Story

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