Closed-loop referral interest
Make a referral that does not disappear into a voicemail.
This page begins a non-emergency conversation about clubhouse, peer, practical support, workforce, or community pathways. It is intentionally not a clinical intake form.
General referral request
Concept visualization This form is not monitored as an emergency service.
For immediate danger, call 911. For mental health or suicide crisis support in the United States, call or text 988. Do not use this website to report abuse, threats, overdose, active violence, or another time-sensitive emergency.
Who may refer
A person may arrive through several doors.
Self or family
A person may request information for themselves or a loved one without submitting clinical details.
Treatment or recovery partner
Discharge planners, counselors, peers, housing staff, and program teams may request a warm handoff conversation.
Court or reentry partner
Probation, reentry, legal, and justice partners may ask about participation, workforce, or stabilization pathways.
Employer or workforce partner
An employer may request a stabilization, retention, readiness, or support conversation with appropriate consent.
Faith or community partner
A neighborhood, church, outreach, food, or social-service partner may request connection and follow-up.
Open Table team member
Internal teams use the same no-drop logic: owner, next step, date, disposition, and re-engagement when needed.
What happens next
The closed-loop referral sequence.
Request received
The submission is stored privately in WordPress and routed for review.
Minimum review
The team confirms contact information, non-emergency status, service fit, and what kind of conversation is needed.
Outreach
The person or referrer is contacted using the preferred method when possible.
Next step scheduled
Orientation, partner contact, Help Hub planning, or a more appropriate referral is identified.
Disposition documented
The request is not treated as complete until the outcome or reason for closure is known.
Re-engagement when appropriate
If a person unexpectedly drops away, the workflow attempts a respectful, concrete return plan within scope.
Privacy boundary
Share enough to request contact—not a clinical record.
Okay to submit
- Your name and contact information
- The person's first name or initials, if needed
- General reason for contact: clubhouse, work, food, housing navigation, partnership, or another practical need
- Best times and method to reach you
- Accessibility or language needs
Do not submit
- Diagnoses, treatment histories, medications, or clinical notes
- Social Security numbers or government ID images
- Detailed substance-use history
- Court records or protected legal documents
- Insurance cards, medical records, or passwords
- Information about a person who has not consented, unless law and safety require another process
Referral interest form
Give us a safe way to reach the right person.
Submitting this form does not create a clinical relationship, confirm eligibility, or guarantee enrollment. A team member must review and confirm the next step.