Referral

ARMHS Referral Form

Please complete this referral form and submit it, or contact us at info@yzhealthservices.com
and we will get back to you. For questions, please call our main office at (651) 493-9345.

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REFERRAL INFO

CLIENT INFORMATION

GUARDIAN
Are they currently receiving services through Y & Z Health Services:
Are they currently receiving ARMHS from another Provider
Are you currently referring to other ARMHS Providers
Are they currently residing in an Y & Z Health Services facility, Crisis Home, or Hospital:
Are they on a Civil Commitment:
Do they have a Staff preference:

MENTAL HEALTH INFORMATION

(Please attach a Release of Information for the following)

Please select yes or no
Does the individual have a current DA within 12 months?
Click or drag a file to this area to upload.
If No- please indicate Client's availability to schedule a Diagnostic Assessment with RTI's Clinician:
Preferred Days: