Make a Referral

To make a referral, please email intakereferrals@recres.org, send a fax to 216-761-1598 or complete and submit the form below.

Name of Patient *

Date of Birth *

Address

City

State

Zipcode

Email Address *

Phone Number *

Insurance Name

Name of Policy Holder

Member Number

Group Number

Referred By *

Reason for referral/services being sought: *

Mental Health

Substance Use/Addiction

Gambling Addiction

Medication Management

Housing

Employment

Case Management

* Required fields