Recovery Referral Form

TLC Recovery Programs offers support groups and recovery coaching for those with addiction (substance abuse and non-substance addiction) in recovery. If you have a client, patient, student, friend, etc., you feel could use our services, please fill out the form below.

Please Use this referral Form

* Indicates required field

Organization name *

Provider phone number *

Provider name *

First

Last

Individual being referred *

First

Last

Reason for this referral *

Has this client given written permission for you to communicate with TLC Recovery Programs for this referral? *

Yes No

Submit

Recovery calendar

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