550 North Eisenhower Drive Beckley, WV 25801 (681) 207-7105

Lifeline Addiction Specialists

"We're Here to Be Your Lifeline"

Coordination of Care

Patients- Lifeline uses GoFormz™ service to facilitate coordination of care (referrals) for providers and patients. Please click on the button below to be redirected to the GoFormz™ application. Patients please complete all fields available to complete in this form and then hit the 'submit' button. Lifeline/FOP coordinator will fax this form to your referring provider to complete their portion. Lifeline/FOP may reach out to you with any questions.


Click HERE to start Coordination of Care Form

Consumer Choice

Patients- Lifeline uses GoFormz™ service to facilitate Consumer Choice notification and documentation for patients. Please click on the button below to be redirected to the GoFormz™ application. This form allows Lifeline to hold the authorization for the insurance carrier for services to be billed.


Click HERE to start Consumer Choice Form

Overcome Your Addiction With Us!
Call today!
(681) 207-7105
and
Click here to start New Patient Application / Global!