For Providers
Please contact us with any questions about the completion or submission process for the following forms.
Click Here for information on Agreement to Cooperate requirements
Provider Forms
Application for Residential Rehabilitation Services, PDF (RRP)
Child & Adolescent Care Coordination Referral Form (CCO)
Consumer Support Funds Application Form
Homeless ID Project Application Form
Homeless ID Project Verification Form
Permanent Supportive Housing Referral
Provider Resources (Accreditation/Licensure/MDH/BHA/COMAR/Optum/NPI)
Thinking about becoming a behavioral health provider in Harford County? Click below to learn more: