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Partner with us

Submit a Client Referral

We work closely with healthcare providers, community agencies, and legal professionals to ensure seamless, coordinated care for those seeking substance use disorder treatment.

Referral Information Form

Please provide details about the individual you are referring, along with your contact information so our intake team can coordinate care.

1. Referring Agency / Provider Information

Your Name *

Agency / Organization

Your Email *

Your Phone

Relationship to Patient

2. Client / Patient Information

Client Name *

Client Phone

Reason for Referral / Additional Notes

3. Programs of Interest *

Select every program you believe may be a good fit — you can choose more than one.

Adult Outpatient Program Youth Outpatient Program Youth Early Intervention Services Medication Assisted Treatment (MAT) Recovery Bridge Housing — General / Men Recovery Bridge Housing — Women & Children Recovery Bridge Housing — Fathers & Children

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