External Behavioral Health Referrals

Hello Valued Community Partner,

Thank you for your referral to Axis Health System. In most instances, a staff member will contact the referred individual within 2-3 business days from the time this referral is received to assist the referred individual in enrolling in services. A follow-up notice with the referral disposition will also be sent to the referring party within 30 days. Please call 970-252-3200 or email referrals@axishealthsystem.org with any questions.


The procedure for scheduling aftercare appointments post-inpatient placement is as follows:

  • To request appointments for patients residing in Montrose, Delta, Ouray, Gunnison, or San Miguel Counties, call 970-252-3203 and request to speak with a Discharge Coordinator or Case Manager. Please fax the patient’s discharge summary to 970-425-3172.
  • To request appointments for patients residing in Durango, Cortez, Dove Creek, or Pagosa Springs, please call 970-403-0180 and request to speak with a Discharge Coordinator. Please fax the patient’s discharge summary to 970-403-0190.


Need help now? 24/7 Axis Care Line is 970-247-5245.


Thank you,

Axis Health System


* Required Fields

REFERRING AGENCY INFORMATION

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Please select this flag so that the referring agency can be added to the list.

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Please list your name, phone number, email, and/or fax number. This contact information is important for a follow-up with the referring agency.

30-Disposition Delivery Preference

PATIENT INFORMATION

Please enter Guardian name if person referred is a minor.

Please enter Guardian phone number/email if person referred is a minor.

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If applicable.

Has the person referred had a positive depression screening?*

If "yes" was selected for Positive Depression Screening, please enter the date of the screening here.

Patient's Primary Language*

Please enter the nearest location to the patient's physical address to see all available services below.

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WHICH PROGRAMS ARE YOU REFERRING THE PATIENT FOR?


Select the appropriate "Nearest Clinic Location" above to populate the available services below.

Behavioral Health*
DUI*
DUI 4+*
Substance Use Treatment (SAOP)*
Substance Use Intensive Outpatient (IOP)*
Integrated Dual Disorder Treatment (IDDT) *
Psychiatric Services*
OP Restorative (OREST)*
Vocational Rehabilitation*

PATIENT REFERRAL CONSENT

Patient Understands and is Aware of Referral?*
Patient Gives Permission for Axis to Follow-up?*
Is a Release of Information Attached?*

Please attach any additional referral documentation here.

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