MAKE A REFERRAL

Challenging as it may be, referring a potentially impaired colleague, employee, friend or loved one is a courageous act of compassion. If you are considering making a referral, please know that this could be the first step in supporting the well-being of a licensee. 

If you are concerned about a healthcare professional, you can contact us by phone, email or complete the on-line referral form. A clinical staff member will respond, listen to your concerns and provide information and suggestions. The professionals themselves can also contact us directly. We can reach out to your colleague or loved one and let them know that concerns have been expressed ( we will not provide your name unless you would like to be involved). We will invite the healthcare professional to meet with us to discuss concerns, offer support and plan next steps. In most cases, we will request that the healthcare professional undergo an evaluation to help clear up concerns. From there, we can work with the professional to create a roadmap to address concerns.

Mandated Referrals

If you are an employer and would like to make a formal referral or are mandating that your employee self-report to UPHP, learn more on our Employer page.

The information you provide is confidential in that UPHP will not share your name or any details you have provided with any other person or entity. Exceptions to confidentiality are outlined here. Learn more about confidentiality here. The information you provide on this form will only be seen and accessed by UPHP staff.

    Our Services

    Education & Outreach

    I would like to schedule a presentation.

    Confidential Monitoring & Advocacy

    I would like to learn more.

    Consultation & Support

    I am looking for support or I am concerned about someone and need some information.

    Wellness Resources & Referrals

    I am looking for resources to help with substance use, mental health or other life stressors.