Suboxone Referral Program
Referral Form for Clinics, Hospitals, Counselors & Attorneys.
We welcome referrals for patients who need safe, stable, and compassionate Suboxone treatment.
Our team works closely with referring providers to ensure continuity of care and timely patient outreach.
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How to Refer a Patient
Please download and fill:
01
Complete the referral formOur contact information: +1 414-404 0900
02
Fax or email it to our officeOur team will contact the patient within 24–48 business hours03
Conditions We Accept Referrals For
Opioid use disorder
Chronic opiod dependence
Patients transitioning from detox programs
Patients requiring ongoing Medication-Assisted Treatment (MAT)
Referral Form Details
Referral form includes:
01
Patient demographics
02
Contact information
03
Diagnosis
04
Previous treatment history
05
Referring provider information
Ready to Submit a Referral?
Download Suboxone Referral Form
Email the Completed Form