Would you like to make a referral to Hope Harbor?
The following 4 items need to be completed and faxed to 712.213.4034 for consideration of admission. Additional information will be requested upon provider approval.
- Copy of complete History and Physical within the past 6 months.
- Recent lab work: CBC, BMP and UA within two weeks of admission.
- Complete form list of attempted medical and non-medical interventions used including dates and outcomes for the past few days. Click to download the Hope Harbor Admission Form.
- Copy of front and back of Medicare and other insurance cards.
Please let us know if there is anything else we can do for you. We want to make this process as easy as possible for you.
Please call if you have questions: 712.213.8656