Make a Referral – Substance Use Outpatient Treatment

Make a referral for substance use outpatient, intensive outpatient, counseling and other related services. We can usually get referrals in for the initial visit within 24-48 hours of the request.

We have provided Substance use treatment in Wake County NC since 2001.
Our Masters Level and Certified clinicians facilitate IOP groups and provide individual and family counseling.
Our Medical Director/Psychiatrist provides psychiatric evaluations and provides ongoing support.
Please complete that attached form and forward it by email to “info@firststepnc.com” or fax to (919) 833-8894. We are usually able to enroll new clients within 24-48 hours.

Client Payment Options

For substance use treatment and counseling First Step Services, LLC is in network with most insurance companies that operate in our area.
For outpatient Mental Health, First Step is currently in network with BCBSNC, Cigna, and Aetna. For clients with other insurance carriers, payment is due at the time of service. We will provide invoices for clients to submit for reimbursement.

To view and print the form, click here!

You can also fill out the form below online and submit it to us directly.

Referral Information

Your Name (required)

Your Phone (required)

Your Email (required)

Reason for Referral (required)

Details for Referral

Has the client previously had an assessment? (required)

Is there an existing Mental Health and/or Substance use diagnosis? (required)

If so, please list all diagnoses

CLIENT INFORMATION

Client Full Name (required)

Date of Birth (required)

Gender (required)

Social Security Number

INSURANCE INFORMATION (if known)

Primary Insurance Company

ID Policy Number

Group Number

Claims Address

Phone Number

Policy Holder’s Full Name (if different than client)

Date of Birth

Gender

Social Security Number

Phone

Effective Date of Insurance

Patient Relationship to Insured

Please ensure HIPAA compliant Authorizations to Release Information to First Step Services, LLC are in place and properly signed by the patient or client and the discharge notes or summary are available.