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 info@asac.us.

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