REFERRALS
Continue to our referral form
Our referral intake is hosted on Microsoft Forms, a third-party service used by CHE under a signed Business Associate Agreement (BAA) for the handling of protected health information (PHI). By continuing, you will leave cheservices.com and submit your referral through Microsoft's platform.
Before you continue
- Only submit information you are authorized to share under HIPAA and applicable state privacy law.
- Review our Notice of Privacy Practices for how CHE uses and discloses PHI.
- In an emergency, do not use this form. Call 911, or 988 for a mental-health crisis.