Referral Form

Click here for a printable version of this form.

Referral Agency
MM slash DD slash YYYY
Name of Person Referring
Address
Referral Agency
MM slash DD slash YYYY
Address

Johnson city

926 W. Oakland Avenue, Suite 206
Johnson City, TN 37604

423.282.3379
info@catalysthealth.org

Bristol

2426 Lee Highway, Suite 104
Bristol, VA 24202

423.282.3379
info@catalysthealth.org

Business Hours

Mon. Tue. Thur. Fri:
8am – 5:30pm

Wednesday:
8am – 7pm

*No person will be denied services based on race, color, sex, national origin, disability, religion, age, sexual orientation, gender identity or inability to pay. A sliding fee discount program is available for those who qualify.

©2022 | Branding Iron *This project is funded under a Grant Contract with the State of Tennessee, Department of Mental Health and Substance Abuse Services

©2022 | Branding Iron *This project is funded under a Grant Contract with the State of Tennessee, Department of Mental Health and Substance Abuse Services