Are you a Physician or Doctor’s Office who would like to refer a patient to Midwest Behavioral Health?
Please fill out the form below to start the process of a new patient referral. You will still need to FAX patient notes to 812-401-8201, ATTENTION: INTAKE. Should you have any additional questions, please call our office at 812-401-8008.
Don’t see the form below? Click here to launch the form in a new window.
SSL SECURED FORM