Middle River Sober Living

For Treatment Centers

The following form is intended for use by case managers and other rehab facility personnel. Please fill out all the required information about your client and include any case information in the proper sections. We will respond promptly to discuss availability and placement. Thank you!

Your Name (required)

Your Treatment Center (required)

Your Email (required)

Your Phone Number(required)

Client's Name

Discharge Date:

Case Details: Please include pertinent info about the client's case (financial situation, job, family support, mental health issues, age, medication, etc.)