Mental Health Referral/Request/Question Agency Referral Form - VA NY Harbor Healthcare System
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VA NY Harbor Healthcare System

 

Mental Health Referral/Request/Question Agency Referral Form

VA NY Harbor Healthcare System offers a comprehensive program of Mental Health services that are recovery oriented and Veteran-centered. Our program addresses a wide spectrum of mental health needs across a range of mental health settings, including emergency services, inpatient and residential care, intensive ambulatory programs and other outpatient care. We focus in particular on mental health issues of concern to veterans such as PTSD, military sexual trauma, traumatic brain injury, substance abuse treatment and psychosocial recovery aimed at helping veterans return to meaningful and productive lives in their community.

Please complete the referral request form below and a VA Mental Health professional will respond to your inquiry within 48 hours. Please do not include any personally identifiable information such as Veteran's name, social security number, mailing address, email address, etc.

Referring Agency:

Name:

Title:

Email Address:

Telephone:

Brief summary of circumstances and needs:


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