Blue Cross Blue Shield of Texas
Patient Referral Portal

Get Started
with Forge Today!

Available to certain members of the following plans based on plan design: Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas. Please check with your plan for details

Please provide your information:

First Name:*

Last Name:*

Date of Birth:*

Address:*

City*

State*

Zip Code*

Mobile Number:*

Email:*

SMS Consent*

Yes

By entering my mobile number and checking this box I agree to opt in to receive important messages from Forge Health regarding appointment reminders, events, and general information about our services. Msg frq varies Text HELP to 36732 for help, Text STOP to 36732 to end. Msg&Data Rates May Apply. By opting in, I authorize Forge Health to deliver SMS messages using an automatic telephone dialing system and I understand that I am not required to opt in as a condition of purchasing any property, goods, or services. By leaving this box unchecked you will not be opted in for SMS messages at this time.

Email Consent*

Yes

By entering my email and checking this box I agree to receive email communications from Forge Health regarding appointment reminders, events, and general information about our services. I understand that I can unsubscribe from these emails at any time by following the unsubscribe link provided in each email.

Insurance information:

Insurance Provider

Member ID:*

Your member ID can be found on your insurance card. If your member ID is alphanumeric, please include both the letters and numbers you see on your card.

Plan Type:*

Forge Health partners with most major insurance companies. *Medicaid and Medicare are accepted at select locations.

Insurance Card Upload (Front)

Max. file size: 256 MB.

Insurance Card Upload (Back)

Max. file size: 256 MB.

Service inquiry:

Are you looking for services for Mental Health or Substance Use?*

Mental Health

Substance Abuse / Addiction / Alcohol

Other

What type of service are you interested in today?*

Individual Therapy

Group Therapy

Psychiatric / Medical Services

Tell us a little more about how we can best support you:*

CAPTCHA

Blue Cross Blue Shield of Texas Patient Referral Portal

Get Started with Forge Today!

Please provide your information:

Insurance information:

Service inquiry:

Blue Cross Blue Shield of Texas
Patient Referral Portal

Get Started
with Forge Today!