Carelon Behavioral Health Referral

Starting care begins with one signed form.

Before we can request authorization through Carelon Behavioral Health, we need a signed attestation confirming you'd like to receive services with Share Wellness Center. It only takes a few minutes to complete.

  • 1 Download the form Use the button to save the Carelon attestation PDF.
  • 2 Complete and sign Fill in participant and provider details, then sign by hand.
  • 3 Email it back to us Send the completed form to info@sharewellnesscenter.com.

Download and complete our attestation form, then return it by email to: intake@sharewellnesscenter.com

This is Carelon's official attestation form for discharging conflicting or overlapping authorizations under Maryland's non-overlap requirement.

Download PDF Form
PDF · Carelon Behavioral Health — Maryland