If this is your first time making a referral to Samaritan House, please read our “Referral Process” below before downloading the “Screening Evaluation/Referral” and “Guest Rules”.

After completing the Screening Evaluation/Referral please fax back to Samaritan House along with the signed Guest Rules. We will contact you once we have reviewed the referral. Please be sure to leave an active contact number for us to contact you.

To be used by authorized medical facilities and personnel ONLY!