Admission Page Information
Birch Tree Communities generally accepts only referrals who are residents of the State of Arkansas. To obtain more information contact:
Starla McCallister, Director of Admissions
Birch Tree Communities, Inc.
P.O. Box 1589 • Benton, AR 72018
Phone: (501) 303-3109 • Fax: (501) 303-3180
starla@birchtree.org
Pre-admission forms
Click here to download information needed for initial referral. All forms must be completed:
Serious Mental Illness Certification Form
SSA- 787 form/Physician's-Medical Officers Statement of Patient's Capability to Manage Benefits
ValueOptions- Change in RSPMI Primary Provider (please be careful to fill out complete form and have signed by a witness)
Request for Financial Information form
Guardian Consent form (Please include guardianship order and have signed by a witness)
Birch Annual Physical Exam form (must also have current TB test results)
Authorization for Release of Information form
Explaination of Social Security form SSA 4164 (Must be signed by a witness)
