(Clinical notes can be provided through upload via this form at the bottom; fax (802) 258-3788 or email Outpatient@brattlebororetreat.org)

Upon receipt of completed referral and clinical notes, the next steps are as follows:

Patient responsibility:

• Complete and return the program packet (assistance is available if requested)
• Attach insurance card images

Brattleboro Retreat steps:

• Financial eligibility will be reviewed within 24 business hours.
• Clinical review to determine program eligibility.
• Patient will be contacted with next steps.