This information is for Health Care Providers only. If you are wishing to refer a family member or friend please visit the Help page of our website.

To make a referral to one of our programs:

ASAC requires the following information:

  • Client full legal name
  • SS#
  • DOB
  • Address
  • Phone Number
  • Insurance/plan name, provider or ID
  • Recent assessment or discharge ASAM completed by a qualified substance abuse professional with recommendation for the level of care patient is being referred to and biopsychosocial history.
  • Referral source, reason for referral.

For residential programs only, the following additional information is requested:

  • Medical history, list of medications and physical record
  • TB Documentation within the past year

Remember – ASAC is a nicotine free campus!

Please send referral information via secure email to

We can also receive via fax (319.390.4381) or you can call the office you are making the referring to.

on September 30 • by