Òù69³ÉÈ˵çÓ°Íø

This form is for primary care providers to use when referring an individual to Òù69³ÉÈ˵çÓ°Íø. Anyone is welcome to call to seek services, a PCP referral is not necessary.  

Òù69³ÉÈ˵çÓ°Íø PCP Referral Form

If you are referring your patient to our Community Rehabilitation and Treatment program, you must also fill out the CRT Referral Form.

CRT Referral Form

Securely grant permission for the sharing of your vital medical information, ensuring a smooth and coordinated healthcare experience.

Authorization to Release Medical Information Form

Voice your concerns and initiate a resolution process by providing essential details about your experience, helping us maintain our commitment to exceptional service and care.

Medical Grievance Manual

Grievance Form

For additional details about the Òù69³ÉÈ˵çÓ°Íø Portal, view the FAQs document.