Get help now!
Make a Referral
Our Services
What We Do
Programs
NBH Difference
Careers
About Us
Mission / Vision
Our Team
FAQs
News
Pricing
Contact Us
Locations
Media Inquiries
Select Page
Coming Soon
Coming Soon
Media Inquiries
Name
Email
Phone
Reason for Inquiry
×
Submit Request
Name
(Required)
Email
(Required)
Phone
(Required)
Reason for Inquiry
(Required)
Is this a Referral
(Required)
Select
Yes
No
N/A
×
Get Help Now
Name
(Required)
Email
(Required)
Phone
(Required)
Reason for Inquiry
(Required)
Is this a Referral
(Required)
Select
Yes
No
N/A
×
Name
Email
Phone
Insured
Select
Yes
No
N/A
Name of Referral
Relationship to Referral
If applicable, please have the following documentation ready for out intake specialist to better assist you.
Face Sheet/Demographic
Most recent H&P with vitals, height, weight, and BMI
Insurance Card
Physician Orders and Treatment
MAR/Medication List
Most recent Labs, Diagnostic Tests, Lipid Panel, and Skin Assessment
Psychiatric Notes/Nursing Notes/Behavioral Logs (previous 72 hrs.
Legal Guardianship/Power of Attorney (if applicable Code Status/Advanced Directives
Comments
This field is for validation purposes and should be left unchanged.
×
