Making a Referral

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To submit a referral, please download and fill out the form below. Please fill it out entirely and ensure that adequate contact information is provided.

 A staff member from the Behavioral Health Division of Jackson County DHHS will contact the referred individual (or parent/guardian) within 3-5 business days to collect further information. Our team of professionals will review your referral information, and an appropriate follow-up will be completed. 

Important: If you or your organization is completing a referral on behalf of another individual, the determination of the referral will not be shared without a signed release of information by the referred individual (or parent/guardian in case of a child or ward).  Regardless of the circumstances, please know that the individual must be informed of the referral before submission. 

If you need assistance making a referral, please call 715.284.4301 ext. 303 or send us a message. 

 The completed form may be mailed, faxed, or emailed to Jackson County Behavioral Health

Mail: 421 County Road R, Black River Falls, WI 54615 

Fax: 715.284.7713 

Email: BHReferrals@jacksoncountywi.gov