BH/GH Client Referral Form

Hospitals, detox facilities and other treatment programs: Please include the following medical records with the referral: 1) History and Physical 2)TB Test 3)Medication List 4) Nursing Assessment 5) Biophysical History 6) Psychiatric Evaluation 7) Other Pertinent Information
ALL UPLOADS MUST BE IN PDF FORMAT

Judicial system / court referrals: Please include a release of information through the court system for our staff to communicate with the court system and any court order mandating treatment.

Please upload supplemental information. Or submit in one of the following ways:
1. Fax to 504-821-7296
2. Email to clinical@bridgehouse.org (Include in subject line: [Client Name], Online Client Referral Form Submitted [Date of Submission], Additional Medical Documents or Additional Court Documents)
3. Turn in at our lobby at 4150 Earhart Blvd during business hours (M-F 8am-4:30pm)