Contact Page
Referral Form
This page will help professionals and partners submit the right information for a referral without creating confusion about consent, privacy, emergencies, or service fit.
Need help right now?
- If someone is in immediate danger, call 911.
- If someone may be overdosing, call 911 and give naloxone if available.
- For mental health or substance use crisis support, call or text 988.
- Referral forms are not monitored 24/7 and should not be used for emergencies.
Who This Form Is For / Before You Submit / Suggested Fields
Referral audiences
Health and social service providers, schools, courts, legal partners, community agencies, treatment partners, and family members if approved.
Before submitting
Confirm the person knows a referral is being made, identify safe contact, avoid emergencies, and include consent/release status if required.
Referrer fields
Name, organization, role, phone, email, and relationship to the person being referred.
Referral fields
Name, safe contact, date of birth if required, reason, requested services, urgency note, consent status, and brief notes.
What Happens Next, Related Service Links, FAQ, Sources
Review
Hope Council reviews the referral and checks whether the request fits available services.
Follow-up
Staff may contact the referrer or the person referred using the safest method provided.
Referral direction
If another service is more appropriate, staff may provide guidance or referral direction.
Who can use the Referral Form?
This answer will identify approved referral sources and clarify whether non-professional referrals are accepted.
Do I need consent to refer someone?
This answer will explain consent/release expectations based on Hope Council workflow.
Referral language will be reviewed by staff for privacy, consent, required fields, and intake workflow.