SAGE Counseling Referrals
To refer clients, use our Referral Form (pdf) and fax it to (480) 649-3358,
or fill in the form below
and click the Submit button to have it emailed to SAGE.
Please have your client complete and sign our Release of Information Form (pdf)
and fax it to our office. Or fax us your own authorization form.
You can also call us directly at (480) 649-3352.
ADC Services ReferralPlease click here
Client Name :
Substance Abuse Treatment - sessions :
Lapse / Relapse
Motor Vehicle Reinstatement Evaluation
Drug Education - hours :
DUI Services :
Level II Education ;
Level I Treatment (hours)
-- please choose --
Screening - Clinical staff will determine the necessity and level of treatment. Discount not eligible for the screening fee.
E-mail a copy of the referral to me
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