REFERRAL & INTAKE
Please Choose a Referral Type Below
Mental Health Services Refferal
This page gives you two convenient options to Submit a Referral.
- WEB BASED FORM – Use our convenient and secure Web-Based Referral Form to submit all your information directly through the web-browser.
- PRE-FILLED PDF – If you have already completed our fillable PDF Referral Form – you can upload that by clicking on the “Click Here to Upload a PDF Referral Form” below. You do not have to complete the web referral if you’ve filled out the PDF. You will upload the PDF to this form. Download our PDF Referral Form here. There is a button at the end of the PDF form to submit the form. It will bring you back to this page to upload it once complete.
Roots Recovery Addiction Treatment