Contact Us - Behavioral Health Services Of Virginia

Hit enter to search or ESC to close

Home
Services
ABA
Insurance options
Employment
Our team
Contact Us

Online Referral Form

- Step 1 of 5

Which location are you inquiring about? *

Richmond
Fredericksburg
Tidewater

Which service are you interested in? *

Mental Health Skill Building (Adult)
Crisis Stabilization (Child/Adult)
ABA (Applied Behavioral Analysis) Child
Intensive In-home (Child)

Name of person completing this form *

First

Last

Phone number for person completing this form *

Email address of person completing this form *

Confirm Email

Name of individual being referred *

First

Last

Referred individual's gender

Is the individual being referred a minor? *

Phone number of individual being referred *

Referred individual's address *

Address Line 1

Address Line 2

City

State

Zip Code

The individual's insurance provider *

Member Policy #

Insurance Card

Click or drag files to this area to upload. You can upload up to 5 files.

Current mental health diagnosis if known: *

Is the individual being referred taking any medications? *

If yes, please tell the individual to bring a list of prescribed medications to the assessment.

Picture of prescription bottle

Click or drag files to this area to upload. You can upload up to 5 files.

Why are you referring this individual for a mental health assessment at this time? Please provide as much detail as possible. *

Is the individual experiencing suicidal or homicidal ideation *

Do you feel the individual will be safe from self-harm until they can be seen? *

Does the individual have a court order to enroll in in mental health services? *

Yes
No
Unknown

Does the individual have any legal history for *

Violent crime
Assault
Sexual offense
Domestic violence
Not Applicable

Captcha *

What is 1+1?

Comment

Our Locations

CEO DEMARIO ADKINS

Direct contact
Call Now

804-873-5502

Call Now

RICHMOND OFFICE

1201 Old Francis Rd.
Glen Allen, VA 23059

804-261-4163

Call Now View Maps

FREDERICKSBURG OFFICE

10401 Courthouse Rd, Suite B
Spotsylvania, VA 22553

540-931-0006

Call Now View Maps

TIDEWATER OFFICE

1500 E Little Creek Rd Ste 204
Norfolk, Virginia 23518

757-881-0589

Call Now View Maps

The right help at the right time

Reach out now

About Us

Established 2012, we are a leading provider of mental health services for at-risk youth and persons with mental health disabilities in the State of Virginia.

Services

Intensive Home Services
Crisis Stabilization
Trauma Informed Care
Mentoring
ABA
Mental Health Skills Building

Subscribe Now

Contact Information

+1 (804) 261-4163
admin@bhsva.net
1201 Old Francis Rd.
Glen Allen, VA 23059

Home
Services
ABA
Insurance options
Employment
Our team
Contact Us