If you are a healthcare provider, friend or family member looking to make a referral to Central Florida Behavioral Hospital, please complete and fax the downloadable referral form below or submit your referral using the online form. Additionally, we ask that patients complete our Request of Information form prior to admission if possible to ensure that the hospital is able to communicate with community providers regarding updates on patient care and for discharge planning. All completed documents may be faxed to 407-264-7739.
Alternatively, providers or individuals making a referral can call our intake center directly at 321-247-7275 to schedule a no cost assessment with our qualified team of registered nurses and/or masters level clinicians. When calling our intake department to refer someone for a an assessment, please provide the following information so that we can best serve the patient:
- Your name, relationship to the patient and phone number. A brief description of the patient’s problem and reasons for referral.
- Patient’s name, date of birth, social security number, address, and phone number.
- Insurance company, insured’s name, policy number, company phone number (if available)
- Any special instructions regarding treatment program, doctor preference, release of information or follow-up with you if you are a clinician.
- What time we can schedule the patient to be assessed.
Online Referral Form