Get the free Burrell Behavioral Health Referral Form

BURRELL BEHAVIORAL HEALTH REFERRAL FORM Client Name Male DOB Female Age Address County City State Phone Alternate Phone Guardian? Yes No Zip Ok to call If yes, Guardian name Yes No Relationship Address

How to fill out burrell behavioral health referral

How to fill out a Burrell Behavioral Health referral:

1. Start by obtaining a referral form from Burrell Behavioral Health. This form can usually be found on their website or requested from their office.
2. Fill out the client's personal information, including their name, address, phone number, and date of birth. This information is crucial for identification purposes.
3. Provide the client's insurance information, including their insurance provider's name, policy number, and any necessary authorizations or pre-approvals.
4. Indicate the reason for the referral by specifying the client's primary concern or mental health condition. It is important to be as detailed and accurate as possible, as this will help determine the appropriate services and treatment options.
5. If the referral is being made by a healthcare professional, include their name, contact information, and any relevant medical history or diagnoses. This additional information can provide valuable context for the referral process.
6. After completing the referral form, review all the provided information for accuracy and completeness. Double-check if any required fields or signatures are missing before submitting the referral.
7. Finally, submit the referral form to Burrell Behavioral Health according to their designated instructions. This can be done either in person, by fax, or through an online submission portal if available.

Who needs a Burrell Behavioral Health referral?

1. Individuals seeking specialized mental health services or support.
2. Those experiencing emotional or psychological challenges that require professional intervention or treatment.
3. Clients who have been recommended by their primary care physician or other healthcare professionals for further assessment or counseling.
4. Individuals who are interested in accessing specific programs or services offered by Burrell Behavioral Health, such as substance abuse treatment or child and family therapy.
5. Anyone who may not be familiar with available community mental health resources and would benefit from a direct referral to Burrell Behavioral Health.

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What is burrell behavioral health referral?

Burrell Behavioral Health referral is a process of referring individuals to Burrell Behavioral Health for mental health services.

Who is required to file burrell behavioral health referral?

Healthcare providers, social workers, or other professionals may be required to file Burrell Behavioral Health referrals.

How to fill out burrell behavioral health referral?

Burrell Behavioral Health referrals can be filled out by providing necessary information about the individual's mental health needs and contact information.

What is the purpose of burrell behavioral health referral?

The purpose of Burrell Behavioral Health referral is to connect individuals with the mental health services they require to improve their well-being.

What information must be reported on burrell behavioral health referral?

Basic information about the individual's mental health condition, contact information, and reason for referral must be reported on Burrell Behavioral Health referral.