In an emergency, call 911.
Mental health or substance use crisis? Call or text 988, 24/7.
This form is not monitored in real time.
Make a Referral
Refer an adult for substance use treatment at Papilion, in person or by telehealth anywhere in Utah. Providers, case managers, courts, family members, and people seeking care for themselves can all use this form.
Same-day confirmationWe confirm every referral the same business day.
First session within 72 hoursBenefits are verified before the first appointment.
About 10 minutesOnly share what you know. Our intake team completes the rest.
Information submitted here is confidential and protected under HIPAA and 42 CFR Part 2. The form is delivered and stored by Papilion IRC’s secure Google Workspace account. Nothing you enter is stored on this website. Questions: 385-378-9435 or info@papilionirc.com.