Referral Forms

A repository of Benton County Health Department’s documents from the “Referral Forms” category.

ACT Universal Referral Form

in Behavioral Health Referral Forms

If you think ACT is a good fit for you, you can work with your provider to fill out and submit this referral form.

ACT-Universal Referral Form (OHA 200-476400) File extension: pdf File size: 341 kB

BH Children’s Outpatient Referral

in Behavioral Health Children & Family Referral Forms

BH Children’s Outpatient Referral File extension: pdf File size: 739 kB

BH School Based Referral

in Behavioral Health Children & Family Referral Forms

BH School Based Referral File extension: pdf File size: 337 kB

BH Wraparound Program Referral

in Behavioral Health Children & Family Referral Forms

BH Wraparound Program Referral File extension: pdf File size: 369 kB

BH Intensive Care Coordination Referral

in Behavioral Health Children & Family Referral Forms

BH Intensive Care Coordination Referral File extension: pdf File size: 888 kB