Thank you for referring your clients to us. We are committed to providing them with the best care possible. We are also committed to helping you better serve your clients with mental health and substance abuse issues. Several tools are available to help do this. You may need to download the free Adobe Acrobat Reader.

Community Provider and Medical Office Referrals:

Below is the online version of our standard referral form with instructions on how to submit to Samaritan Behavioral Health.

Provider Referral Form (PDF)

Children Service Division Referrals:

Below are the online versions of our standard referral forms with instructions on how to submit to Samaritan Behavioral Health.

CSD Referral Packet (PDF)

CSD Referral Packet – Preble County Only (PDF)

Referrals to Samaritan Behavioral Health outpatient services must contain the completed referral packet to meet regulatory requirements and initiate our diagnostic evaluation. After we have received the completed information, we will contact the foster parent to schedule an intake appointment.