800-826-0940 | 920-720-1300

Behavioral Health Forms


Depression Referral  .pdf

Halfway House AODA Services .doc | .pdf

Outpatient AODA Services - Initial  .doc | .pdf

Outpatient AODA Services - Concurrent  .doc | .pdf

Outpatient Treatment Request - Initial   .doc | .pdf

Outpatient Treatment Request - Concurrent  .doc | .pdf

Residential AODA Services - Initial  .doc | .pdf

Residential AODA Services - Concurrent  .doc | .pdf

Obtain a Prior Authorization

Please contact our Care Management Department or our Behavioral Health Services department to request a prior authorization.  Click here for a list of contact phone numbers.