REFERRAL FORM

Children who are 5 years and above are eligible for our program with a referral from the treatment coordinator, psychiatrist or any licensed clinician providing treatment to the minor. Any adult and minor with severe mental health diagnosis is eligible to be served by our program. BFSS only accepts consumers with Medicaid. We can also refer individuals to other providers for other mental or behavioral health specialty or any other health care needs identified while receiving services at our program. Fees are reimbursed by Medicaid, there are no cost to consumers.

We will accept outside referrals from the following:

• self
• parents
• legal guardians
• nurses
• social workers

• teachers
• counselors
• doctors
• psychologist
• schools

• health facilities
• churches
• departments / social services
• juvenile services
• and the court systems.

The main office will be open Monday through Friday from 9:00am - 5:00pm and on Saturdays from 10:00am - 2:00pm.

All staff members are available by cell phone or other electronic means of communication 24 hours, 7 days a week to respond to crisis. Our main phone number is 410-656-2142. Email address: info@mybfss.com. Contact us today!