OPTIONS Community Referral Form

The form is intended to provide a pathway for members of the public to provide minimal information to our Kennebec and  Somerset County OPTIONS Liaisons for follow up or outreach to a person struggling with Substance Use Disorder (SUD). The liaison assigned the referral will contact the person making the referral for supplemental information as needed prior to making contact with the person they would like to connect to support.

Please complete this form with as much information as you have available when making a referral to the OPTIONS Program.

Referral Information

Contact Name(Required)

Your Information

Your Name(Required)

Contact Our Team 

(207) 626-3448 

Outpatient Office Locations

10 Caldwell Road
Augusta, ME 04330-5735

120 Tillson Avenue
Rockland, ME 04841

346 Water Street
Skowhegan, ME 04976

Outpatient Office Hours

Monday - Thursday: 8:00 am - 4:30 pm
Friday: 8:00 am - 4:00 pm