Referral Form
REFERRING AGENCY PLEASE SEND ASAM FOR 2.5 LEVEL OF CARE AND CLINICALS
Provider & Self-Referral to The Orenda Center of Wellness
Providers please email the following if available:
client‘s most recent diagnosis, most recent history and physical, current medication list, recent lab work, and any recent assessments.
Follow up with your mental health and addiction treatment center referral at 240-831-4873
Please fax this form to 240-366-1851
or email this form to :
