Referral forms

Here are forms for professionals to use when referring a client to Rosecrance. Choose the appropriate form and fax it to the number on the sheet. Fax numbers are confidential. You can also email it to referral@rosecrance.org.

If the client is in an emergency situation, call 815.391.1000 instead of using the form.

Chicago Area Referral Form

Rockford Area Referral Form

Wisconsin Referral Form