Now accepting new clients, free, confidential benefit check, no obligation.

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Refer a Client

Refer a Client

Please complete this form to refer a client to Royce Recovery Behavioral Health. Our admissions team will review your submission and follow up with next steps.

Download Client Referral Form

Please fill out the form below or download a copy and fax it to (469) 219-8136.

Download Client Referral Form

"*" indicates required fields

1. REFERRAL SOURCE

2. CLIENT INFORMATION

Address

3. INSURANCE

Payer

4. REASON FOR REFERRAL

Service Requested
Current thoughts of harming self or others?