Eligibility

Should you be in need of a referral you can click below on the appropriate form.  Please note referrals must be signed by a licensed clinician; if you are not currently working with a licensed clinician, contact our office and we can assist you through the process.  Completed referrals are to be directed to the Program Director, Sam Richberg, if unable to bring it into the office it can be sent either via:  



email:  shanitam@allen-ayukbehavioralhealth.com 


or 


fax:  443-221-7879 (Annapolis Office in AA County)


fax:  240-582-7378 (Landover Office in PG County)


REFERRAL FOR SERVICES

We provide comprehensive treatment to children, adolescences, adults, and families throughout the state of Maryland.  To be eligible to receive services an individual must have all of the following:


1)  Maryland Medicaid;

  • if not, we accept self-pay.



2)  Currently working with a licensed clinician;

  • if not, we can provide assistance identifying clinicians in your network.



3)  Must be at least 5 years of age or older




4)  If over the age of 18 a psychiatric diagnosis that meets the “priority population” criteria



ALLEN-AYUK BEHAVIORAL HEALTH

              WE SUPPORT.  WE ADVOCATE.  WE EMPOWER.  YOU ACHIEVE.

For ABHC Adult Referral Form please click here

Referral forms cannot be submitted through the website, it must be emailed, faxed, or brought into the office.

For ABHC C&A Referral Form please click here