Make a Referral

Our team will respond to this referral request within 24 hours; however, for immediate assistance call our intake department at 817-261-3121

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General Release of Information (ROI)

Please use this General Release of Information form if you’re requesting your own medical records or if you’re a provider coordinating care with our clinical team. Please download the ROI, sign it, and return it in person, email it to [email protected], or fax it to (817) 261-1483. You may revoke this authorization in writing at any time if needed.

Download the Release of Information Form

School Release of Information (ROI)

To support your student’s treatment and ensure a smooth return to school, we ask families to complete a School Release of Information. With your written permission, our clinicians can share essential updates (e.g. safety plans, recommended accommodations) with school staff, and receive pertinent information from the school to coordinate care during treatment and plan for discharge from Millwood Hospital or branches. Please download the ROI, sign it, and return it in person, email it to [email protected], or fax it to (817) 261-1483. You may revoke this authorization in writing at any time if needed or if your child will be transitioning to a new school upon discharge.

Download the School ROI Form