Referral inquiry

Submit Preliminary Inquiry

Share a few non-clinical details and our team will follow up to discuss general needs and program fit. This is a preliminary inquiry, not an application or a guarantee of placement.

Insurance credentialing, AHCCCS Complete Care plan contracting and private-pay arrangements are being established ahead of our opening. We'll go over the client's coverage with you on the call back.

Goes straight to Randy Godwin, Clinical Director. Prefer email? randy@bhofm.com

Referral source *

Your name *

Organization

Phone *

Professional email *

Best time to contact

e.g., weekday mornings

We'll call you back to talk about the client. Please don't share any client names or health details here.

I consent to Better Half of Me Behavioral Wellness contacting me about this preliminary inquiry. *I acknowledge the Privacy Policy and understand this form is not for confidential medical information. *

This form is for preliminary referral inquiries only and should not be used for emergencies, crisis communication or transmission of confidential medical records.