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Professional Referral

Refer a Client

Fill out this quick form and our admissions team will reach out within one business day. Confidential, no obligation, and no cost to refer.

Worried About Losing Your Job? Get Help Without Walking Away From Your Career.

Your job may be protected while you take the time you need to get treatment, recover, and come back stronger.

If you're struggling but afraid to step away from work, you may have options. FMLA can provide eligible employees with job-protected medical leave, and your private medical information is protected by law. We can help guide you through the paperwork so you can focus on what matters most—getting healthy and coming back stronger.

Click your state to see your rights
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Or choose from a list:

Want more detail? See the full Know Your Rights guide →

What your client gets
  • ✓ A peer-led team, many in recovery themselves, so your client is understood from day one
  • ✓ A full continuum of care: medical detox, residential, PHP, IOP, outpatient, and sober living
  • ✓ Free, same-day insurance verification, most major PPO plans accepted
  • ✓ Licensed, DHCS-certified care in Burbank, CA, with admissions available 24/7

Want to talk it through first, or refer by phone instead?

844-R-REFORM

Professional Referral Form

Use this form to refer a client for treatment. We'll follow up with you directly, not with your client, unless you ask us to.

Please fill in the required fields and try again.
Who is making this referral?

Enter the name of whoever is referring the client — a professional, family member, or friend. If you're the client and no one referred you, write "Self."

Client information

If you are the client, put your own name and info here.