Refer someone to Northstar.

Give us the essential information first. Northstar will handle the full intake directly with the prospective resident when appropriate.

$250/week30-day scholarships available case by caseIOP available 3x weekly

Referral Form

A referral does not guarantee admission. Northstar staff reviews next steps.

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1 · Who is making the referral?

Referrer type *Your name *Your email *Your phone *

2 · Who are you referring?

Person's name *Age, if known Phone, if known Email, if known Current city / state, if known

3 · Do they know about the referral?

Does this person know you are referring them to Northstar? *

YesNoUnsure

Have they agreed to be contacted directly by Northstar? *

YesNoUnsure

4 · What do they need?

Reason for referral *

Recovery housing IOP / PHP / treatment MAT Case management Peer support Re-entry / probation support Unsure — help determine needs

How urgent is the referral? *Where are they currently?Insurance / Medicaid status, if knownAnything important we should know before contacting you?

I confirm the information above is accurate to the best of my knowledge. I understand Northstar will use the awareness and contact-permission answers above to determine whether to contact me first or contact the person referred.

Keep the referral simple. Northstar will collect detailed clinical, recovery, legal, and intake information directly from the prospective client when appropriate.

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