• Referral for Services

    Referral for Services

    Serving Monroe, Vernon, and LaCrosse Counties
    • Disclaimer Information 

    •  TO REFER OR NOT TO REFER? 

      When a person is expressing the need to change, wanting more information about exploring recovery, this is a time to share this resource with them. We will connect them with a Peer Specialist, Recovery Coach, or Parent Peer Specialist (known as a "PEER").

    • REQUIREMENTS:

      1. The person requesting support needs to have a substance use disorder or concern for their substance use.
      2. The person requesting support needs to express that they want support to explore, get into, or stay in recovery.
      3. Please complete the referral as thoroughly as possible and submit.
      4. Once NEXT STEPS FOR CHANGE receives the referral information, we will assign a "PEER" and they will make contact with the participant or you - depending on the circumstances.
      5. By submitting this referral the person who you are referring acknowledges they know they are being referred for peer support and agrees to be contacted by our team to set up and receive services.

    • PARENT PEER SPECIALISTS: 

      1. Parent Peer Specialists are available for parents who are coping with the challenges of having a child (of any age) who is struggling with a substance use disorder. Our Parent Peer Specialists will walk alongside the parent to support the individual with their own challenges surrounding their child’s substance use disorder.


      2. Please put the parents’ name in the Participant’s section. Please include in the "Any
      additional information you would like to share" section that they are a PARENT looking for parent peer support.

    • Please provide information for the person making the referral in the next section: 
    • Please provide demographic information about the person wishing to receive services: 
    •  / /
    • Please provide contact information for the person wishing to receive services (One form of contact information is required so we may reach you) : 

    • Ways to contact recipient of services:

    • Please provide basic referral information for the person wishing to receive services: 
    •  - -
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