Make a Referral
Health Connect America earns the trust and faith of our referral source with each assignment we fulfill.
To make a request for medical records, school notes and/or documentation please send an e-mail to the appropriate region.
Please select a location for the online form —or— you may download a print file and fax it to our local office.
| Online Referral - Abingdon, VA |
Download PDF, Referral - Abingdon, VA |
| Online Referral - Chattanooga |
Download PDF, Referral - Chattanooga |
| Online Referral - Clarksville |
Download PDF, Referral - Clarksville |
| Online Referral - Cookeville |
Download PDF, Referral - Cookeville |
| Online Referral - Gallatin/Nashville |
Download PDF, Referral - Gallatin/Nashville |
| Online Referral - Franklin |
Download PDF, Referral - Franklin |
| Online Referral - Jackson |
Download PDF, Referral - Jackson |
| Online Referral - Johnson City |
Download PDF, Referral - Johnson City |
| Online Referral - Knoxville |
Download PDF, Referral - Knoxville |
| Online Referral - Martin |
Download PDF, Referral - Martin |
| Online Referral - Memphis |
Download PD,F Referral - Memphis |
| Online Referral - Morristown |
Download PDF, Referral - Morristown |
| Online Referral - Murfreesboro |
Download PDF, Referral - Murfreesboro |
| Online Referral - Savannah |
Download PDF, Referral - Savannah |
| Online Referral - Sparta |
Download PDF, Referral - Sparta |
| Online Referral - Winchester |
Download PDF, Referral - Winchester |
We provide behavioral health treatment and related services within fourteen regional areas of Tennessee and a Health Connect Clinic in Virginia (Abingdon (VA), Chattanooga, Clarksville, Cookeville, Franklin, Gallatin, Jackson, Johnson City, Knoxville, Martin, Memphis, Morristown, Savannah, Sparta and Winchester).
We are readily available to meet the needs of families across the state of Tennessee and Abingdon, VA. Health Connect America serves as a subcontractor for both private and public agencies, and accepts self pay, TennCare as well as third party payers.
