Skip to content
  • CONTACT US
  • PAY YOUR BILL
  • CAREERS
  • 800-264-5640
Rivendell Behavioral Health Services of Arkansas Logo
  • Programs & Services
    • Overview
    • Adult Programs
      • Acute Psychiatric Care
      • Dual Diagnosis
      • Partial Hospitalization (PHP)
      • Intensive Outpatient (IOP)
    • Child & Adolescent Programs
      • Acute Psychiatric Care
      • Adolescent Male Extended Care Unit
      • Substance Abuse
    • Telehealth
    • Services for Veterans, Military, and Dependents
  • About Us
    • Overview
    • Our Facility
    • Our Team
    • Licensing & Accreditation
    • Partnerships
  • Admissions
  • Resources & Events
    • Visiting Hours
    • What to Bring
    • Continuum of Care
    • Events for Professionals
    • Therapeutic Thursdays
    • Video Library
  • Programs & Services
    • Overview
    • Adult Programs
      • Acute Psychiatric Care
      • Dual Diagnosis
      • Partial Hospitalization (PHP)
      • Intensive Outpatient (IOP)
    • Child & Adolescent Programs
      • Acute Psychiatric Care
      • Adolescent Male Extended Care Unit
      • Substance Abuse
    • Telehealth
    • Services for Veterans, Military, and Dependents
  • About Us
    • Overview
    • Our Facility
    • Our Team
    • Licensing & Accreditation
    • Partnerships
  • Admissions
  • Resources & Events
    • Visiting Hours
    • What to Bring
    • Continuum of Care
    • Events for Professionals
    • Therapeutic Thursdays
    • Video Library
Previous

Rivendell

By UHSAdmin|2019-02-18T21:27:04-05:00February 18th, 2019|Comments Off on Rivendell

Share This Story, Choose Your Platform!

FacebookXRedditLinkedInTumblrPinterestVkEmail

About the Author: UHSAdmin

Rivendell Logo White

100 Rivendell Drive
Benton, AR 72019

Toll-Free Phone:
800-264-5640
Local Phone:
501-316-1255

Contact Us

Joint Comish
© Rivendell Behavioral HealthServices of Arkansas. All rights reserved.

Physicians are on the medical staff of Rivendell Behavioral Health Services of Arkansas, but, with limited exceptions, are independent practitioners who are not employees or agents of Rivendell Behavioral Health Services of Arkansas. The facility shall not be liable for actions or treatments provided by physicians. Model representations of real patients are shown. TRICARE® is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved. ATransportation options may be available – please contact us to learn more.

  • HIPAA Notice of Privacy Practices
    • |
  • Nondiscrimination Notice
    • |
  • Price Transparency
    • |
  • Language Assistance
    • |
  • Terms of Use
    • |
  • Privacy Policy
    • |
  • Sitemap
    • |
  • Download Adobe Acrobat Reader
    • |
  • No Surprises Act
    • |
  • Accessibility Statement
    • |
  • Code of Conduct
    • |
  • Compliance Hotline
    • |
  • Text Program Terms
InstagramLinkedInYouTubeFacebook
Page load link

Referral Form

This field is for validation purposes and should be left unchanged.

Treatment Program Interested in

Children & Adolescent Programs
Adult Inpatient Programs
Adult Outpatient Programs

Demographics

Patient Name

Insurance

Guardian's Name
Is user a professional?

Referral Source/Physician/Therapist

Referring Provider's Name
Agency/Clinic/Practice Address

How did you learn about us?

How did you learn about us?
Which social media?

Reason For Referral

Check all that apply
How would you prefer to complete the level of care assessment?

Additional Information

Upload any supporting documents that may assist with the referral/assessment process such as: Medication list, Insurance Card, Recent discharge Paperwork, School documents/IEP, Current Treatment Records, Psychological testing/evaluation, Therapy or psychiatric records, Letter of Recommendation-If for Sub-Acute program
Drop files here or
Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 25 MB, Max. files: 15.
    Go to Top