Referral/Admission Inquiry Form

It begins with a phone call. When you or someone you know is in crisis, let us help. Crescent Pines Hospital offers no cost assessments to make recommendations for treatment.

Crescent Pines Hospital accepts referrals 24 hours a day/7 days a week from professional referral sources, family members, and consumers. To make a referral or schedule a free and confidential assessment, you can complete the form below or call Crescent Pines Hospital at:

Main: (770) 474-8888
Fax: (678) 593-4801

Do not use the form below if you have a medical emergency or urgent problem. Instead, please call us at 770-474-8888. If you need immediate medical assistance, please contact 911 or seek the nearest Emergency Room. Any information submitted using this form is transmitted securely and held in strictest confidence, protecting your privacy.