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If you feel that you are a danger to yourself, please pause filling out this form and contact the National Suicide Prevention Lifeline at 1-800-273-8255 or 911.

If you are unable to call Erlanger Behavioral Health Hospital at (423) 380-1005, please use the form provided below to submit a confidential message to our admissions staff. We will respond as soon as possible.

Please note that by leaving your contact information in the space provided, you consent to allow Erlanger Behavioral Health Hospital to use this information to contact you. Any information provided will remain confidential. Please note that by choosing to not leave your information, the staff at Erlanger Behavioral Health Hospital will not contact you.





Disclaimer: Erlanger Behavioral Health Hospital disclaims any liability, loss, or risk sustained directly or indirectly as a consequence of any actions you take with this form.