Professional Referral | Hope Restoration Center
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For Healthcare Professionals

Refer a Patient to
Hope Restoration Center

Simple, safe, and straightforward. Complete and submit the referral form below and our intake team will follow up during normal business hours.

🧑‍⚕️ Licensed Clinical Team 📧 Email Response Guaranteed 📍 Sandy, Utah
Get in Touch
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Phone
+1 (801) xxx-xxxx — Coming Soon
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Hours
Mon – Fri: 9:00am – 5:00pm MT
Lunch: 12:00pm – 1:00pm (Closed)
Sat – Sun: Closed
A member of our team will contact you if further information is required

Refer a Patient to Hope Restoration Center

Hope Restoration Center accepts referrals for outpatient and intensive outpatient program services, including clinical evaluation, treatment, and care coordination. To refer a patient, please download and complete the secure referral form below, then upload it or upload your organization's referral form with any supporting clinical documents.

Our intake team will review the information and route it to the appropriate department. Referrals may be submitted through our secure portal or via the HIPAA-compliant email address listed below. Thank you for your enquiry. A member of our team will contact you if further information is required.

Phone support is also available. Click here for contact info.

Please note: Submitting a referral does not guarantee admission, insurance approval, or placement in a specific level of care.

Simple. Safe. Four Steps.

1
Fill the form
Your name, role, and phone number only. No patient details.
2
We email you
Our clinical team will respond during normal business hours.
3
We discuss
We follow up by email or phone — whichever you prefer.
4
Client placed
Your patient is assessed and placed in the right program.
Referral Form
Just your contact details and a program preference. Our team handles the rest over the phone.
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Keep it simple and safe: Do not include your patient's name, date of birth, diagnosis, or any personal health information in this form. All clinical details will be collected securely by our team over the phone after we contact you.
Your Details
If different from your phone number above.
Referral Preference
What happens after you submit
1
Request Received — Your basic contact request is sent to Hope Restoration Center for follow-up during normal business hours.
2
Intake Follow-Up — Our intake team will contact you during normal business hours to answer general questions, review referral details if applicable, and discuss next steps by phone.
3
Program Guidance — If appropriate, we will help determine which of our outpatient behavioral health services may be a good fit and explain the next steps for consultation, scheduling, or referral to the appropriate level of care.

Thank you for your enquiry. A member of our team will contact you if further information is required. No patient information is required in this form.

Important: This form is for general intake contact purposes only. It is not a secure clinical data channel and should not be used to transmit patient names, dates of birth, diagnoses, insurance information, or any other protected health information (PHI). All clinical details must be shared with our team verbally by phone or via secure fax after initial contact has been established. Hope Restoration Center is committed to maintaining the privacy and confidentiality of all patient information in accordance with applicable federal and state law.
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Request Received

Thank you. Our clinical team will follow up with you during normal business hours.

Need support by phone?

Our intake team is available Mon – Fri, 9:00am – 5:00pm MT (Lunch: 12:00pm – 1:00pm (Closed)).

📧 Email Us 📞 +1 (801) xxx-xxxx — Coming Soon