Make a Referral
Fax completed forms to: 844-834-2678
ArkSTART Urgent and Referral Line: (888) 570-2146

Referral Packet

Download and complete the Referral Packet below to alert ArkSTART about a person with IDD & behavioral health needs who may potentially face a crisis situation without intervention.

IMPORTANT: All parts of this packet must be completed at the time of the referrel for it to be valid and considered for services.

Consent for Release of Information

Must be completed before evaluation can begin

Consent for Evaluation and Treatment

Must be completed before evaluation can begin

Notice of Privacy Practices

Must be completed before evaluation can begin