This information is for Health Care Providers only. If you are wishing to refer a family member or friend please visit the Get Help page of our website.
To make a referral to one of our programs:
ASAC requires the following information:
- Client full legal name
- 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 email@example.com.
We can also receive via fax (319.390.4381) or you can call the office you are making the referring to.