Refer yourself to Caladrius Therapy's DBT Program
We appreciate you seeking out DBT! Use this quick referral form to share basic info about yourself and your situation. We’ll review your information and follow up promptly (within 48 hours).
Client information
Client name
*
First Name
Last Name
Client phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Client email address
*
example@example.com
Client date of birth
-
Month
-
Day
Year
Date
Are you willing to take part in a 15 minute consultation call?
*
Yes
No
What insurance do you have?
*
Please Select
Blue Cross and Blue Shield of North Carolina
Aetna
Cigna (now Evernorth Behavioral Health)
UnitedHealthcare
Optum
MedCost
Humana
Tricare
Ambetter
Medicaid (NC Medicaid / NC Health Choice)
Medicare
None (self-pay/private pay)
Other
Your interest in DBT
How did you find out about DBT?
What are you hoping DBT might help you with?
What is the name of your referring provider (if any)?
Submit
Should be Empty: