Referral Form
Use this form if you are referring to our Adolescent Mood & Anxiety Program or for any patient with counseling needs. You can fax this form to 850-270-6932 or email it to our Program Coordinator, Kailee, at kailee_neves@blscounseling.net.
ED Referral Form
Use this form for referring patients with eating disorders. You can fax this form to 850-270-6932 or email it to our Program Coordinator, Kailee, at kailee_neves@blscounseling.net.
Please note that clients who have CHP insurance, a prior authorization form must be submitted directly in the CHP portal via TTAP (see referral process below)
Collaborating Medical Provider Attestation Form
We require all of our Eating Disorder Recovery Program clients to have a Primary Care Provider (PCP) willing to coordinate care with us for potential medical needs during treatment. This includes providing a recent physical exam and ordering new labs. A client’s PCP will need to complete/sign this form in order for us to schedule the assessment. For questions, please call Kailee at 850-765-6769.
CHP Referral Process for an ED Assessment
For clients that have CHP insurance, prior authorization is required by CHP before we can proceed with scheduling the initial assessment. We need your assistance with this step so included is a referral guide.
BLS Release of Information Consent Form
BLS Recovery Center Release of Information Consent Form
Consent is required to communicate with and release medical records to providers. You can fax this form to us at 850-270-6932 or email to Kailee at kailee_neves@blscounseling.net.
Our team at BLS has a collaborative spirit in efforts to help motivate and guide our clients as they embark on a journey to incorporate balance and wellness into their life. Thank you for allowing us the opportunity to cooperate with you to provide our clients with the best possible care. Be Well, Be Real, Be You
~ Danielle Shelton, CEDCAT, Founder & CEO of Better Living Solutions
Our team works hard to create a collaborative and mutually beneficial environment for both clients and providers. These are a few materials that will be helpful in our referral processes. If you need more information, please feel free to give our office a call at 850-765-6769 and ask for our Program Coordinator, Kailee, or via email at kailee_neves@blscounseling.net.