IRT Patient Referral
To ensure that the individual meets the IRT Eligibility Criteria, please follow the steps
below:
1. Review Eligibility Criteria: Ensure that the individual qualifies for our IRT program by
reviewing the specific eligibility criteria outlined on our website.
2. Patient Referral Form and Release of Information: If the individual meets the criteria,
click the link below to access the Patient Referral Form. The referral form includes the
Release of Information that must be signed by the patient allowing ECBH to
communicate with the facility or care home where the individual will reside.
Important Information for Patients
Before submitting the referral, it’s crucial to present the patient with a clear
understanding of the services offered by ECBH. Ensure they are informed about what
enrolling in our IRT program entails, including the benefits and support they will receive.
By filling out, completing, and signing these forms, you confirm that the patient is aware
of their treatment options and has chosen ECBH as their primary mental health
prescriber and therapy provider. This agreement is essential in protecting the rights of
every patient we serve.
Get Started
To begin the referral process, please click the link below:
Submit Patient Referral Form by clicking here
You can also download a copy of our Referral form with the Release of information
Here.
Thank you for your commitment to supporting individuals on their journey toward
recovery. If you have any questions or need assistance, please do not hesitate to
contact us!