Download referral forms for all of CIHS' programs below.  

Forms for Download

Authorization to Use or Disclose PHI Form

Each referral needs to have a completed ROI attached. Use the links below to download an ROI form.

Use the link below to download the ROI form for the SUD (Adult and Youth) program.

Referral Forms

Use the links below to download the referral form for the program you wish to refer to.

Submit Referrals

Submit the referral form with a completed ROI either by the fax number or email below.