Refer an Employee

Substance Abuse Professional (SAP) Referral Form

This referral is for an employee who is in violation of your Alcohol and Drug Policy, or has self-disclosed an issue with substance use that warrants an assessment by a Substance Abuse Professional. The process for the SAP Assessment involves an initial assessment of the employee with our clinician, after which a report will be created and forwarded to the Designated Employer Representative (DER) noted below. The employee will return for a follow-up assessment after completing recommended treatment.

Please ensure that the SAP process has been explained to the referred employee. Please note the employee will sign a Release of Information at the initial appointment noting consent to have appropriate information released to the DER. If you are referring to another program or have additional questions please contact our office at 888-617-2279 or at

Massages OK? (required)

Is this a referral for a DOT SAP assessment? (required)