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Online Referral Forms

Use the following links to complete referral forms using encrypted, HIPAA compliant technology.
If you have any questions or need assistance, please call (505) 830 1871.

Bernalillo County Referral Form
Doña Ana County Referral Form
Rio Arriba County Referral Form
Sandoval County Referral Form
Santa Fe County Referral Form
Valencia County Referral Form

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Printable Referral Forms

Please find links below to all of our Referral Forms in PDF format. Please note that these forms vary by county and program. Please download and fax the completed forms to the fax number indicated on the document. If you have any questions or need assistance, please call (505) 830 1871.

Bernalillo County Referral Form
Doña Ana County Referral Form
Rio Arriba County Referral Form
Sandoval County Referral Form
Santa Fe County Referral Form