Forms

Information & Assistance Referral Form

Follow the procedures printed on the referral form carefully. 

Click for the Referral Form

*Note – If the person being referred is a TennCare enrollee, you MUST contact the MCO.  The phone numbers are listed below. 

Amerigroup 1-866-840-4991

United Health Care 1-877-552-8106

Bluecare 1-888-747-8955