Secure Referral Form

If you are interested in a referral please have a Health or Mental Health professional download and complete the referral form below and include a copy of your most recent psychiatric evaluation.  These items can be mailed or faxed to us. Upon receipt and review of these materials, the Program Director will contact you to make an appointment to do an intake assessment and share details of the service.  This appointment will take place in your home.

Professionals desiring to make a referral. Please download and complete the referral form below and include a recent psychiatric evaluation.

Please contact the NLAM Office with any questions you may have.
Phone: 717.390.4891   Fax: 717.390.4894

DOWNLOAD Referral Form (.pdf)