Inter-Agency Referral

​Brindamos servicios en español. Por favor llame a nuestro (707) 544-3295 para obtener ayuda.

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THIS REFERRAL FORM IS FOR INTER-AGENCY REFERRALS ONLY. IF YOU ARE A CLIENT SEEKING TREATMENT PLEASE USE THE CLIENT ENROLLMENT FORM.​

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​The Inter-Agency Client referral process is as follows:

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1. Complete the Inter-Agency Referral Form below. 

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2. An Admissions Counselor will process the referral, and we will begin tracking this case. 

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3. You will receive an email confirming we have received your referral.

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4. If needed, an acceptance letter will be generated and sent to the contact information provided within 48 business hours. 

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5. An Admissions Counselor will follow-up with you by email or phone to confirm the client entry date.

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It is important that client's follow the instructions provided in their acceptance letter or other enrollment communications.

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ALL INFORMATION PROVIDED HERE IS ENCRYPTED, CONFIDENTIAL, AND WILL BE PROTECTED UNDER FEDERAL AND STATE CONFIDENTIALITY LAW.​