Referrals

This information is for Health Care Providers only. If you are wishing to refer a family member or friend please visit the Help page of our website.

To make a referral to one of our programs:

ASAC requires the following information:

  • Client full legal name
  • SS#
  • DOB
  • Address
  • Phone Number
  • Insurance/plan name, provider or ID
  • Recent assessment or discharge ASAM completed by a qualified substance abuse professional with recommendation for the level of care patient is being referred to and biopsychosocial history.
  • Referral source, reason for referral.

For residential programs only, the following additional information is requested:

  • Medical history, list of medications and physical record
  • TB Documentation within the past year

Remember – ASAC is a nicotine free campus!

Please send referral information via secure email to info@asac.us.

We can also receive via fax (319.390.4381) or you can call the office you are making the referring to.

on September 30 • by