POLARA HEALTH
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      • Support Group for Parents of Special Needs Children
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CLIENT REFERRAL TO POLARA HEALTH

  • Referrals are accepted for behavioral health services 24 hours a day, seven days a week.
  • An acknowledgment of receipt of the referral shall be provided to the referring party on the next business day.
  • We will offer a range of appointment availability and flexible scheduling options based upon the needs of the client.
Picture
Please complete the contact form below or
download the attached pdf and fax the completed form to:
928-445-0126
How to Complete the Referral Form
File Size: 29 kb
File Type: pdf
Download File

Polara Health Referral Form
File Size: 151 kb
File Type: pdf
Download File

    Client Referral to Polara Health

    Insurance Information
    All Referrals will be contacted within 1 business day and offered an intake within 7 days.
    Max file size: 20MB
    Max file size: 20MB
Submit

​BEFORE YOUR FIRST VISIT

Are you preparing for your first appointment with us?
Thes
e documents may be helpful as you get ready:
  • Overview of Intake/First Appointment Process
  • Notice of Privacy Practices |  Notice of Privacy Practices, SPANISH
  • Financial Assistance Summary English
  • Financial Assistance Summary Spanish
  • Financial Assistance Application English
  • Financial Assistance Application Spanish
  • Financial Responsibility Form
  • Financial Consent Form
  • General Consent/Conditions of Admission
  • Part A Questionnaire
  • Client Rights & Responsibilities Form
  • Medication List
  • Specialized Screenings
  • Release of Information Form
For information in another language call:  (928) 445-5211
Para información en Español llame: 
(928) 445-5211 ext 3198 or ext. 2016
​

CONTACT US

Walk In Crisis Location:
8655 E. Eastridge Drive
Prescott Valley, AZ 86314
Hours: Open 24 hours, 7 days a week
Crisis helpline: 928-445-5211 X1
A telehealth specialist is ready to take your call.

Telehealth - Zoom Information
The Zoom Link:  https://zoom.us
Meeting ID: 954 0369 1857
Passcode: 946460
 
The Telephone Numbers
Dial/join by phone
1-253-215-8782 or
1-346-248-7799
Meeting ID: 954 0369 1857
Passcode: 946460


Copyright © 2021 Polara Health | Web Design: Sadie Sarti Design Co.
  • Home
  • Services
    • Continuum of Care
    • Adult Clinical Services
    • Children & Family Services
    • Primary Care & Psychiatry
    • Senior Peer Program
    • Substance Use Disorders
    • Vocational Services
    • Windhaven Psychiatric Hospital
  • Crisis
    • Intervention
    • Resources
    • Success Stories
  • Learning Center
    • Webinars
    • Support Groups >
      • Support Group for Parents of Special Needs Children
      • Community Connections
    • Videos
  • About Polara
    • Mission, Vision & Values
    • Staff
    • Governance Board
    • Accreditation & Policies
    • Billing
    • Blog
    • Newsletters
  • Contact
    • Contact Us
    • Client Referral
    • Locations
  • CAREERS
    • Career Opportunities
    • Applications
  • SUPPORT US
    • Donate
    • Different Ways to Give