Hope Harbor Referral Process

Would you like to make a referral to Hope Harbor?

Referrals can be made by a family member, friend, psychiatrist, doctor, nursing home, hospital or community agency. An older adult may also make a self-referral.

The following four items need to be completed and faxed to 712.213.4034 for consideration of admission. Additional information will be requested upon provider approval.

If you submit a referral during business hours and have not heard from us within two hours, please call us at 712-213-8656. You may also email the referral paperwork to Hope.Harbor@bvrmc.org.

  1. Copy of complete History and Physical within the past 6 months.
  2. Recent lab work: CBC, BMP and UA within two weeks of admission.
  3. Complete the Hope Harbor Admission Form below, including attempted medical and non-medical interventions used with dates and outcomes for the past few days.
  4. Copy of front and back of Medicare and other insurance cards.
Hope Harbor Admission Form


Please call 712.213.8656 or email Hope.Harbor@bvrmc.org if you have questions. We want to make this process as easy as possible for you.