Recovery Resources · Make a Referral

Make a Referral

Thank you for contacting Recovery Resources.

Someone will contact you within 24-48 hours of your submission. You can also email intakereferrals@recres.org or send a fax to (216) 761-1598.

Contact Information

In order to respond to your inquiry, we need the following information from you.

First Name of Patient *

Last Name of Patient *

Date of Birth *

(mm/dd/yyyy)

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Email *

Verify Email *

Phone *

Insurance Name

Name of Policy Holder

Member Number

Group Number

Referred By *

Reason for referral/services being sought. (you may choose more than one) *

Mental Health

Substance Abuse/Addiction

Gambling Addiction

Medication Management

Housing

Employment

Case Management