BHN Addiction & Recovery Services Request Form

Please complete this form to request a call back from a member of the SUD intake team.

If you are in need of immediate medical attention, please follow up with your local hospital or call 911.

If you are in need of immediate withdrawal services, we recommend coming in as a walk in to: Carlson Recovery Center, 471 Chestnut St, Springfield MA.

Walk-in Hours:

Monday - Friday 8am - 8pm (including all holidays)
Saturday & Sunday 8am - 4:30pm

This form does not take the place of a referral, a member of the team will follow up to assist you with making a referral to the programs listed below. Please allow for 24 to 72 hours for a call back.

If you have questions, call (413) 301-9355.

If you are interested in a referral for our Counseling and Wellness services, please click here: Behavioral Health Network Referral

Are you requesting services for yourself?

Name of person seeking services:

Date of Birth

Persons contact information:

Persons email address

Is the person seeking services pregnant?

Yes

Unknown

Is the person seeking services currently unhoused?

Yes

Unknown

Community Support

Recovery Coach Services

Recovery Support Navigator

Inpatient Program of Interest

Inpatient programs are detox and clinical stabilzations ervices

Carlson Recovery Center

New View Section 35

Hope Center

Cooccurring Enhanced Programs of Interest

Unity Place

Unity Place South

Are you unsure of program you are looking for?

If yes, please complete the general information option below.

Yes

General Information:

Please briefly describe what you are interested in and a team member will reach out

If you would like to be added to a daily outreach email with our bed availability, please enter your email address:

How did you hear about BHN?

Send me a copy of my responses

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