BE ADVISED.

Please note that PORT Health does NOT call patients about payments. If you receive a phone call regarding payments,

please note the number from which the call was made and let us know. You can contact us contact at 252-830-7551.

ANNOUNCEMENTS

A Clear Path to Recovery

Treatment

Veteran’s Treatment Court

Are you in crisis?

Expand

1-866-488-7678

PATIENT INFORMATION

Full Name *

Date of Birth *

Address *

Phone *

Email *

Insurance Plan Group# Policy# *

Existing PORT Health Patient? *

Yes

No

Prior MH/SUD or MAT Treatment? *

Yes

No

If yes, when?

Release of Information Completed and Attached *

VTC PERSONNEL/CASE WORKER

Full Name *

Address *

Email Address *

Phone *

Fax *

Probation Officer *

Contact Information *

Email Address *

Phone *

Fax *