Resource Forms

Referral Form

Referral Form is to be completed by referring Physicians, Providers, or Agencies.

Medicaid Referral

***Medicaid requires an EPSDT referral form to completed by the primary physicians office***

 

Release of Information

Forms are to be faxed to 855-238-3221 or mailed to 917 Merchants Walk SW, Suite E Huntsville, AL 35801