Apply For Services

Residential Rehabilitation Program:

If the application is for the Residential Rehabilitation Program, please mail this form to the Core Service Agency/Local Behavioral Health of your home county. This information can be found on page 2 of the referral.

*Archway cannot modify this form, because it is issued by the state of Maryland. An updated list of eligible diagnoses can be found here.
The CSA office will then forward this form to Archway, if approved.

Referral Submission Guide

​Psychiatric Rehabilitation Program (PRP):
Adult PRP Referral Form (Community Based Support Services) (Electronic Format)
Adult PRP Referral Form (Community Based Support Services) (Print Format)
CAYA (Child, Adolescent & Young Adult) Referral Form (Electronic Format)
CAYA (Child, Adolescent & Young Adult) Referral Form (Print Format)

Assertive Community Treatment (ACT):
Assertive Community Treatment Team – Community Referral (Print Format)
Assertive Community Treatment Team – Self Referral (Print Format)

Crisis Stabilization – Respite:
Allegany County
Crisis Stabilization Services Referral Form (Electronic Format)
Crisis Stabilization Services Referral Form (Print Format)
Respite Services Referral Form (Electronic Format)
Respite Services Referral Form (Print Format)

Garrett County
Crisis Stabilization Services Referral Form (Electronic Format)
Crisis Stabilization Services Referral Form (Print Format)
Respite Services Referral Form (Electronic Format)
Respite Services Referral Form (Print Format)

Your rights

• We will treat you with courtesy and respect, even when we’re working through a problem.
• We’ll respect your culture and spiritual life.
• We’ll give you information so that you can make informed decisions.
• While we’re providing you services, there won’t be any mental, physical, verbal, or sexual abuse or neglect from staff. Staff won’t humiliate you.
• Staff will not take advantage of you, especially when it comes to your money and things you own.
• We don’t use any sort of chemical restraint. When providing mental health services, physical restraints are not used. When providing services funded by the Developmental Disabilities Administration, physical restraints are used only when pre-approved as part of the person’s behavioral plan.
• We will protect your privacy. Your records are protected and aren’t available to staff who don’t need to see them.
• You can see your Archway records by asking to do so. We’ll respond quickly.
• We share information about you only with your permission.
• You have the right to develop your Individual Plan, as well as the right to have other people help you write it.
• We will do our best to resolve any of your complaints quickly. No one will hold it against you if you complain.
• We are respectful to both the person making the complaint and the person subject of the complaint. The agency is committed to a thorough and prompt investigation while confidentially protecting personal information of all parties involved.
• We’ll let you know how to contact self-help and advocacy services.
• We support your right to follow or not follow your treatment and health plans, including medications.