NC Brookhaven Behavioral Health

Referral Form

  • Interested in receiving services from NC Brookhaven Behavioral Health for yourself?

    Please use the link below to complete the form.

    COMPLETE SELF REFERRAL FORM

  • Are you a referring partner looking to request services from NC Brookhaven Behavioral Health for a patient?

    Please use the link below to complete the form.

    COMPLETE FORM AS A REFERRAL PARTNER