REFERRAL AGENT RESOURCES

Please use the following guidelines to create your Referral Letter:

• Applicant Information

• Present Emotional & Physical Health

• What resource does Applicant have?

• Why Now?

• Healing Program Goals

• Previous Treatment or Healing Program

• Alcohol and Drug History

• Current Relationships

• Referred by Information

  (should include name, address, phone,
  relationship to applicant - eg. Employer, Counselor, AA Sponsor, Physician, Probation Officer, Other & specify);