Referral Interest Form
Thank you for your interest in RHA Health Services! This form is intended for those interested in disability services in North Carolina, Georgia and Tennessee. Please complete all required fields notated with an asterisk. If there is a field or question you do not understand, please select “Unknown.”
In addition, please email supporting documents (i.e., psychological evaluation, Behavior Support Plan (BSP), Individual Support Plan (ISP), and Individualized Education Program (IEP) to the state e-mail where you are seeking services:
North Carolina: email@example.com
If you need any assistance, please contact the RHA Call Center at 1.800.848.0180.
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