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ToRCH Community Program

Self-Referral Questionnaire
Our Community Health Team at Phelps Health is here to help Phelps County Medicaid patients find the resources they need. Just complete this questionnaire, and we’ll be in touch. If you qualify, we’ll connect you with the right support.


Please fill out the following so we can get in touch with you:
Address:*
To qualify for the ToRCH Program, you must meet the following criteria:*
What kind of help are you needing? (select all that apply)*
Do you have a diagnosed medical condition in your health record?*
Have you received help from this program before?*
Have you completed a social determinants of health (SDOH) screening with Phelps Health? (At the Main Hospital, clinics or outpatient setting)*

Thank you for taking the time to apply.

For questions, please email ToRCHinfo@phelpshealth.org or call (573) 458-8338.