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Give us a call at 507-327-9890 to learn more.

Assessments + Referrals


We offer chemical dependency assessments for any age.

Please call 507-327-9890 to set up an appointment. We take cash, credit cards, Blue Plus, South Country Health and UCARE insurance. If you have other private insurance please call to discuss options.  


Please fill out the online form below completely and one of our staff members will contact you.

To download a PDF version of the form, please click on the link below. Fill out the form completely and send to intake either by email at or fax at 507-344-1146.

Download PDF

Online Adolescent Referral Form

  • Referent Information

  • Client Information

  • Parent/Guardian Information

  • Probation Officer/Social Worker Information

  • Insurance Information

  • Client History

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