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Referrals - Short Form

Want to make a referral but prefer to speak with us first? Please fill out the short form below.

Call our Referral & Intake QuickConnect Line for more information or to make a referral.  After referral is completed, it will be assigned to staff as appropriate. Our referral process is a simple phone call that takes 5-10 minutes. Intake will be scheduled at the same time and our goal is to have intake completed within 1 week of referral!

Call Quick Connect at 453-4367 or 1-800-781-8550 ext. 2722
or, fill out our referral form below and we will contact you within 72 hours.

You may also download a copy of the referral form here, and email it to [email protected].


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Funded by State of Maine Department of Health and Human Services (DHHS) and MaineCare.