Refer a patient to Fort Health

Refer a patient to potentially receive behavioral health services with Fort Health.

We'll contact your referral within 1 business day and keep you informed at the contact details provided below.

For questions email refer@forthealth.com.

Insurance networks accepted

Aetna

PHCS/MultiPlan

Cigna/Evernorth

First Health

Blue Cross Blue Shield of Illinois

Refer to one or more program, or let our team determine care options with the family:

Patient Information

Child First Name*

Child Last Name*

State*

Child Date of Birth*

This patient or their legal guardian has consented to receiving email and text messages from Fort Health*

Parent Information

Relation to Patient*

First Name*

Last Name*

Phone Number*

Email*

Referring Provider

Name of Practice, Office, or Clinic*

Referring Provider*

Contact Person First Name*

Contact Person Last Name*

Contact Person Role*

Contact Person Email*

Office Phone Number*

Office Fax Number*

Referral Notes

If you are experiencing a mental health emergency or medical emergency, please call 911 or 1-800-273-TALK (8255) to reach a crisis center or text 741741 to reach the Crisis Text Line.

* This patient or their legal guardian, as may be required, has agreed to receive communications, including emails and text messages, from Fort Health regarding this referral and accessing health care, treatment, and services, and has provided their e-mail address and mobile phone number for the purpose of receiving these communications. The patient/guardian has acknowledged the risks that may be associated with receiving health information via unsecured email or text messaging.

Questions or concerns? You can reach us at care@forthealth.com or at (201) 208-2616

Refer a patient to Fort Health

Insurance networks accepted

Refer to one or more program, or let our team determine care options with the family:

Therapy

Medication Evaluation

Individual Therapy for Parents

Patient Information

Parent Information

Referring Provider