Referral

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Seeking Help for Self or a Loved One

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Caller Relationship

Your Name:*

First Name Last Name

Your Phone Number:*

Your Email:*

Title:*

Organization, please specify branch if relevant:*

If you can't find the organization above please post it here.

Client's Name:*

First Name Last Name

Client's date of birth:*

Client's Preferred Location for Services:

Client's Address:*

Street Address City State / Province / Region ZIP / Postal Code

Client's Email:*

Client's phone number:*

Client's Insurance Type:

Client's Insurance Provider:

Client's Member ID:

Insurance Card Upload (Front of Card):

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Insurance Card Upload (Back of Card):

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What is the client's primary need?*

Mental Health

Substance Abuse

Which level of care are you recommending for the client? (select all that apply)*

Detox

Residential Treatment

PHP

IOP

Virtual IOP

Outpatient

Tell us a little more about the client and their current needs:

Additional Paperwork Upload

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I give or have obtained any necessary consent/authorization prior to disclosing the health information above. The client is aware of this referral and is expecting Guardian Recovery to contact them directly via phone, voicemail, SMS/text, and email as appropriate.*

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Once you submit the form, staff will contact you via phone or email within 24 hours for a free, confidential, and no-obligation conversation to discuss your needs and/or those of a loved one.

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Medical Disclaimer:

The information provided on this website is intended solely for educational and informational purposes. Guardian Recovery aims to improve the quality of life for individuals struggling with substance use or mental health disorders by offering fact-based content about behavioral health conditions, treatment options, and related outcomes. However, this information should not be considered a substitute for professional medical advice, diagnosis, or treatment.

Important Notes:

The content on this site is believed to be current and accurate at the time of posting, but medical information is constantly evolving.
Always seek the advice of your physician or other qualified healthcare provider regarding any questions or concerns about your health or medical condition.
If you think you may have a medical emergency, call 911 or go to the nearest emergency room immediately.
Guardian Recovery does not provide free medical advice. For personalized treatment recommendations, please consult with a licensed healthcare professional.

By using this website, you acknowledge that you have read and understand this disclaimer. Guardian Recovery and its affiliates disclaim any liability for the use or interpretation of information contained herein. SEE TERMS AND CONDITIONS

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Do it for YOU, Do it for LOVED ones

Live a BRIGHTER Future Today!

Guardian Recovery is here to assist you in your journey of healing.

Do it for YOU, Do it for LOVED ones

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Do it for YOU, Do it for LOVED ones

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