This referral form is intended for use by healthcare providers, Community Services Boards (CSBs), hospitals, behavioral health professionals, case managers, social service agencies, and other authorized referral sources.
Please complete the form below with all available information. Submission of a referral does not guarantee admission or enrollment in services. Referrals are reviewed to determine eligibility, medical necessity, and appropriateness for the requested service in accordance with applicable Virginia Department of Behavioral Health and Developmental Services (DBHDS) requirements and program criteria.
If additional information or documentation is required, a member of the intake team will contact the referring source.
For urgent behavioral health emergencies, contact 988, call 911, or go to the nearest emergency department.
