The form is intended to provide a pathway for members of the public to provide minimal information to our Kennebec and Somerset County OPTIONS Liaisons for follow up or outreach to a person struggling with Substance Use Disorder (SUD). The liaison assigned the referral will contact the the person making the referral for supplemental information as needed prior to making contact with the person they would like to connect to support.

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Please complete this form with as much information as you have available when making a referral to the OPTIONS Program.

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OPTIONS Community Referral Form

Referral Information (this is for the person needing outreach)

County

We only serve Androscoggin County.

Your Information

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