Thank You

Home
Thank You

Thank Youdave.sabin2021-06-01T15:42:25-07:00

Thank You!

Thanks for your message! We will be in touch with you shortly.

Help Is a Phone Call Away

If you or a loved one may be in need of behavioral health treatment, call Heritage Oaks Hospital at 916-489-3336. No cost assessments are available 24/7.

Physicians are on the medical staff of Heritage Oaks Hospital, but, with limited exceptions, are independent practitioners who are not employees or agents of Heritage Oaks Hospital. The facility shall not be liable for actions or treatments provided by physicians. Model representations of real patients are shown. TRICARE® is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved.

HIPAA Notice
Nondiscrimination Notice
Standard Services
Language Assistance
Terms of Use
Privacy Policy
Sitemap
Download Adobe Acrobat Reader
No Surprises Act
Accessibility Statement
Your Privacy Choices

We are pleased to support our trusted regional partners in care, Michael’s House and Reasons Eating Disorder Center, with services treating substance abuse and eating disorders.

Please visit their websites to learn more:

Michaelshouse.com | Reasonsedc.com

© Heritage Oaks Hospital. All rights reserved.

Page load link

To make a referral, please complete the items below and click “Submit” to send this confidential form to an Assessment and Referral clinician.

You can also fax it to 1-800-217-6218

Patient Name*
First Last
Patient Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date of Birth*
MM slash DD slash YYYY
Insurance Carrier*
Referred By*
Referral Contact Phone Number*
Diagnosis/Symptoms to be treated/Reason for referring:*
Phone
This field is for validation purposes and should be left unchanged.

This form is monitored during regular business hours only.

For immediate assistance, please call our Assessment and Referral line directly at 916-830-2223.

Download Form

Generic selectors

Exact matches only

Search in title

Search in content

Post Type Selectors

Go to Top