Send us documents securely

Use this form to send Amethyst Behavioral Healthcare paperwork for admission or ongoing care: releases of information, insurance cards, referrals, court or probation papers, and medical records. Only our admissions team can open what you send.

About you

Who are you?

Your full name

Organization optional

Phone

Email or phone, so we can reach you if something's missing.

Who the documents are about

That's you. Enter your name as it appears on your insurance card or ID.

First name

Last name

Date of birth

Helps us match the right person.

Documents

What are you sending?

Sending more than one kind? Pick the main one and tell us in the message.

Files

Choose files or take a photo

or drag them here

PDF, photo (JPG, PNG, HEIC), TIFF scan, or Word document. Up to 5 files, 20 MB each. For a card, send the front and back.

Message optional

I'm the person these documents are about, or I'm allowed to share them with Amethyst Behavioral Healthcare.

Encrypted in transit and stored in Amethyst's private Microsoft cloud.