If you are a client, family member or Licensed Professional who is seeking to self refer for general out-patient, routine treatment please complete the Intake Referral Form and submit to the Intake Department.
If you wish to refer a client to CBHA and you are affilitiated with an In-Patient or Intensive Out-Patient Facility, Hospital or Rehab, we require that you submit the following information three business days prior to client discharge to faciliate client appropriateness and coordination of care;
- Updated Client Demographic Information
- History and Physical
- Psychiatric/Neuropsychological Evaluations**
- Psychiatric/Neuropsychological Testing**
- Laboratory Results**
- Clinical Notes**
- Medication List (current or most recent)
- Discharge Summary including diagnosis and plan of care
**Information to be included on an as needed basis
To contact the Intake Department, please call 860-437-6914 ext. 206 or fax records to 860-823-1170.
When leaving a message for Intake, please make sure to leave your full name, best contact phone number and reason for the call. Remember to speak slowly and clearly and please specify if you require a return call at a certain time of day. Please allow 24 hours for return phone calls, also please make sure that your voicemail box is activated and empty.