Referrals

If you are a provider looking to make an inpatient referral to Sierra Vista Hospital, please use our form below. If you would like to reach the Branches Outpatient Admissions team, please call 916-914-1388 to schedule a free assessment.

Making a referral? Please complete the items below to send this confidential form to an Assessment and Referral clinician.

You can also FAX a referral to 916-688-5440 for Inpatient referrals, or 916-596-2015 for Outpatient referrals.

"*" indicates required fields

Treatment

Inpatient

Outpatient

Other

Patient Name*

Date of Birth*

Patient Phone*

Address*

Insurance Carrier*

Insurance Subscriber ID #*

Referred by*

Referral Contact Phone Number*

Diagnosis/Symptoms to be treated/Reason for referring:*

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First Choice

Second Choice

Third Choice

This form is monitored during regular business hours only.

For immediate assistance, please call our Assessment and Referral line directly at 916-288-0316.

We Are Here to Help!

To schedule a level of care assessment or to learn more about our programs, call us at 916-288-0300.

Call Inpatient 916-288-0300

Call Outpatient 916-914-1388

Admissions Information

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