Referral Center

Connecting clients to the right care, at the right time. Our referral process is fast, confidential, and designed to make care coordination seamless for providers and families alike.

Who May Refer?

We accept referrals from a wide range of providers
and community members, including:

Primary care physicians and specialists
Hospital emergency departments
Mental health professionals and counselors
Courts and probation/parole officers
Social workers and case managers
Schools and educational institutions
Employers and employee assistance programs
Family members and self-referrals
Community organizations and faith communities
Other behavioral health providers

Accepted Referral Types

We accept referrals for the following services:

Outpatient mental health therapy
Substance use disorder treatment (outpatient)
Co-occurring disorder treatment
Partial Hospitalization Program (PHP)
Intensive Outpatient Program (IOP)
Recovery housing placement
Peer recovery support services
Case management services
Medication-assisted treatment (MAT)
Psychiatric evaluation and medication management

What Happens After You Refer?

Our care coordination team moves quickly so the people you care about get the help they need without delay.

Referral Received

Your referral is received and logged by our care coordination team.

Clinical Review

A clinician reviews the referral for level-of-care appropriateness.

Contact Within 24hrs

We contact the client or referral source within one business day.

Intake Scheduled

An intake appointment is scheduled at a convenient time.

Care Begins

Services begin and you receive a confirmation of enrollment.

Supporting Documents

To help us prepare for intake, please submit any available documentation along with your referral. Accepted document types include:

📄 Referral Packets — Clinical summary, assessment, or referral letter
🪪 Insurance Cards — Front and back of current insurance card
📋 Clinical Documents — Discharge summaries, treatment records, lab results
⚖️ Court Documents — Court orders, diversion agreements, probation requirements
📝 Release of Information Forms — Signed ROI authorizing care coordination

All documents are handled securely and in compliance with 42 CFR Part 2 and HIPAA regulations.

📞 Referral Hotline

Phone: (812) 602-4022
Fax: (812) 602-4023
Email: referrals@nowcounseling.us

Hours:
Monday – Friday
8:00 AM – 5:00 PM CST

Frequently Asked Questions

Have questions about the referral process? We have answers.

Q: How long does the referral process take?

Most referrals are processed within one business day. Urgent referrals are prioritized and addressed as quickly as possible.

Q: Does the client need insurance to receive services?

No. We work with Medicaid, Medicare, private insurance, and sliding-scale fees. We will never turn someone away due to an inability to pay.

Q: Can I submit a referral for someone without their consent?

We can receive information about a potential client; however, the individual must provide written consent before services can begin, per HIPAA and 42 CFR Part 2.

Q: What geographic areas do you serve?

New Opportunities for Wellness primarily serves Southern Indiana. Contact us to discuss service availability in your area.

Q: How will I know the referral was received?

You will receive a confirmation call or email from our care coordination team within one business day of referral submission.

📋 Submit a Secure Referral

Complete the form below to refer a client to New Opportunities for Wellness. All information is transmitted securely and handled in strict compliance with HIPAA and 42 CFR Part 2. A member of our care coordination team will respond within one business day.

🔒 HIPAA Secure

⚡ Response in 24 hrs

📞 (812) 602-4022

42 CFR Part 2 Compliant

Please note: * indicates a required field

👤 Referring Provider Information

Referring Provider or Organization Name *

Contact Person *

Provider Phone Number *

Provider Email Address *

Fax Number (for documents)

Type of Referral Source *

🧑 Client Information

Client First Name *

Client Middle Name

Client Last Name *

Date of Birth *

Gender Identity

Client Phone Number

Client Address

City, State, ZIP

🏥 Service Requested

Primary Service Requested *

Urgency Level *

Has the client consented to this referral? *

Preferred Contact Method for Client

🪪 Insurance & Financial Information

Primary Insurance *

Insurance Plan Name (if known)

Member ID / Policy Number (if known)

Group Number (if known)

📋 Clinical Information

Primary Presenting Concern / Reason for Referral *

Current Diagnoses (if known)

Current Risk Level *

Current Substance Use

Current Medications

Previous Treatment History

⚖️ Legal & Special Circumstances

Involved with Criminal Justice System?

Current Housing Situation

Special Circumstances or Additional Notes

📎 Supporting Documents

You may attach documents below. Accepted formats: PDF, DOC, DOCX, JPG, PNG (max 10MB per file). All documents are transmitted securely in compliance with HIPAA and 42 CFR Part 2.

Referral Packet / Clinical Summary

Insurance Card (front & back)

Court Order / Legal Documents

Release of Information Form (ROI)

✅ Certification & Submission

By submitting this referral, I certify that: (1) I am authorized to make this referral; (2) the information provided is accurate to the best of my knowledge; (3) I have obtained or will obtain appropriate client consent in compliance with HIPAA and 42 CFR Part 2 before services begin; and (4) I understand that submission of this form does not guarantee enrollment in services.

I certify the above statements are true and I am authorized to submit this referral. *

Your Full Name (Digital Signature) *

Date of Submission *

Prefer to submit by phone or fax? Call our referral line at (812) 602-4022 or fax documents to (812) 602-4023. Referral line is available Monday–Friday, 8:00 AM – 5:00 PM CST.