Health Information Management Department
Authorization forms requesting Behavioral Health records can be mailed to:
Cumberland Mountain Community Services
P.O. Box 810
Cedar Bluff, VA 24609
Authorization forms can also be faxed to:
Questions about the authorization form can be directed to the Health Information Management Department at 276-345-9761.
Please complete the form in its entirety and include a telephone number where we can contact you.
After reviewing the authorization form, we will contact you at the telephone number you provided.
If you have submitted an authorization form and have not been contacted within 5 business days, please contact the Health Information Management Department at 276-345-9761.
Download The Authorization Form