EXISTING PARTNER REFERRAL FORM

Thank you for continuing to be a valued community partner. Please let us know if you are not receiving our weekly bed availability emails or monthly newsletters. Follow our social media pages to stay up to date with funding availability and ways our program participants can reduce their fees.

We are in need of volunteers for our organization and would love for you to be part of our mission. Just reach out to volunteer@newfoundationsrecovery.org

Name of Referring Organization:(Required)

First Name of Referring Professional(Required)

Last Name of Referring Professional(Required)

Title of Referring Professional(Required)

Phone of Referring Professional(Required)

Email of Referring Professional(Required)

Name of Client Being Referred(Required)

First Last

Phone of Client Being Referred

Email of Client Being Referred

Date

This completed form goes directly to our Intake Department. The next step is to please have your client call our intake department to complete an over the phone assessment to be accepted into our program. We only provide housing to those who identify with having the disease of addiction. We will accept individuals with dual diagnosis under most circumstances. Please call our intake line for any questions, 513-813-2787.

Thank you for being a valued community partner in our mission to help others heal, grow and live.

Please note that the program participant cannot use the Partner Referral Form more than once to waive the intake fee, should they leave and return.

*We add all community partners to our monthly newsletter to help share resources, share specials and important announcements.