Physician Referral

 

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Making a referral to FBHS

Instruct the patient or parent to call our Intake line 440-460-0140 or to go to new patients on our website. A intake specialist will conduct a brief intake interview to obtain clinical and insurance data necessary to determine proper clinical assignment. Intake information is reviewed and the patient is referred to the appropriate clinician. The patient is then called to make an initial appointment. If the clinician is specified by the doctor or patient, the request will be reviewed for clinical and insurance provider appropriateness.

 

We ask that the referring physician send over any pertinent information before the patient’s appointment. You may use this form.

Following the first appointment, the referring physician will be sent a brief note indicating initial diagnosis and treatment plan.

 

       Physicians email

Please list the reason for your referral, when the problems began,
and any special notes.

Specific Provider Requested

Contact Information

Patient Name
Referring Provider
Patient age
Is the patient on psychiatric Medication
What Medications
Phone
Parent or Guardian

 

Send mail to jmorris@fbhsllc.com with questions or comments about this web site.
Copyright © 2005 Family Behavioral Health Services, LLC
Last modified: 05/22/08