Referral form

1. Referrer Information

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2. Patient Information

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3. Billing Info

Upload front of insurance card*
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Upload back of insurance card*
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4. Clinical Info

Treatment Type*
Addiction Type*
Level of Care*
Tell us a bit more how we can help
Upload clinical records*
Please upload your clinical records one at a time. You may add up to 4 files.
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Why Refer to BeBold Recovery?

We provide fast, reliable, and results-driven care—ensuring your referral gets the help they need right away.

Proven Results You Can Trust:

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Proven Success

Over 85% of clients successfully complete their full treatment program.

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Immediate Support

98% of referrals receive same-day assessments and admissions.

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Full Attendance

82% of clients maintain full attendance compliance throughout treatment.

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Drug-Free Success

90% of clients maintain consistent clean drug tests.

We offer a full continuum of care tailored to your referral’s needs, including:

No matter where someone is on their recovery journey, we’re here to help!

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We accept Medicaid and most major insurance plans.

Verify your insurance now!
Anthum logoBright Health Group logoAetna logoCare First logoCigna logo
Anthum logoBright Health Group logoAetna logoCare First logoCigna logo
Anthum logoBright Health Group logoAetna logoCare First logoCigna logo
Anthum logoBright Health Group logoAetna logoCare First logoCigna logo