Connecting with a Care Provider Is as Easy as 1 – 2 – 3 using the Equity Health Center Self-Referral Form

When you are looking for support for your physical or mental well-being, using our self-referral form is a quick and simple way to find the health care services you need.

IMPORTANT: If you are experiencing an emergency, please call 911 for immediate care.

  1. You can go directly to the form by clicking here. It only takes a few minutes to fill out.
    • PLEASE NOTE that under Services there is only one choice: Individual and Family Services. After choosing this, you can explain your needs more specifically in the next section, Please describe your request for services.

  1. After you hit SUBMIT at the end of the form, someone on the Equity Health Center team receives the information. In most cases, you will hear back within 48 hours (2 days) either from an Equity Health Center representative or directly from a care provider that may help you.
  1. If you haven’t received a response after 5 days, feel free to email grace@coatesvillecenter.org for additional assistance.

Whether you need medical care, mental health support, social services, nutritional assistance, or have access issues such as transportation or insurance, we are here to help!

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