How to Refer a Brain Injury Patient to KBIC

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Referring a patient or client to KBIC

Referring a patient or client to KBIC is a quick and easy process. Once you’ve obtained your patients permission, simply fill out the referral form and our Membership Coordinator will take it from there.

If you’re unsure if the person you want to refer would be a good fit for KBIC or have additional questions about our services, the eligibility requirements and FAQs section should help. Want to talk to a staff member, just use the contact form or call our main line.

Refer New Patient Contact Form

(603) 570-2026, ext. 220, via email, via fax at (603) 430-7668, or by filling out the form below. 


This form is for providers to refer a patient. If you are a survivor, family member, or other referral source, please complete our Contact Form here.

Any information provided will be sent in an e-mail to a member of KBIC staff for review and follow-up. Patient information is kept confidential and will not be stored on this website.