Referrals
Welcome to The Alliance of Hope!
- Provide your basic information (name, DOB, contact, insurance)
- Share your insurance card or discuss payment options
- First assessment appointment
- Work with your clinician to create a treatment plan that fits your needs
- Get oriented to our program (rules, rights, resources, scheduling)
- Begin services (individual, family, group, or IOP)
- Ask questions any time – we are here to support you!
- Meet with a clinician for your first assessment (talk about your needs, history, and goals)
- Review and sign forms (consent for treatment, HIPAA privacy notice, telehealth consent if needed)
Protected: Referral
Consumer Information
Services Requested
| Peer Support: Wellness, Whole Health Management, Recovery, Behavioral Structure, Crisis Intervention (Adults only, 2-5 days/ wk.) |
| IFI (Intensive Family Intervention) (3-5 times per week) |
| CORE- Non-Intensive Outpatient Services (NIOP): Individual, Family, and Skills 1-3 visits per week |
Psychiatric Evaluation and Treatment/ Medication Management (must be in conjunction with NIOP or Peer Support) |
Reason For Referral
| History of Counseling Suicidal/Homicidal/Self-Harming Substance Abuse/Dependence Legal/ Criminal Involvement |
| Risk/History of Homelessness Medication Use Hospitalization Out of Home Placement DFCS Involvement |
| History of Abuse/Trauma Psychological/Psychiatric Eval completed (please attach to referral) Anger Issues Psychosis |
| Disruptive/ Violent/ Destructive Behavior Other: |