Referring Clients


If you are interested in treatment with the Minnesota Chemical Dependency Program for the Deaf and Hard of Hearing please contact the Central Intake Department at 1-800-233-7503 (voice) or 612-672-2736 (voice) if you are calling Monday-Friday between the hours of 7:30am-4:30pm CST.

If you call after business hours please leave a message for the Deaf and Hard of Hearing Program at 651.964.1427 (video phone) or  612.273.4402 (voice). Your message will be returned the following business day.

Family members, counselors, or potential clients are invited to contact us.

Application Process:

  1. Complete an Intake Worksheet and the Modified Simple Screening Instrument for Substance Abuse. The information can be forwarded to the potential client via mail, fax, or email or it can be printed here (insert link for both PDFs).
  2. After you receive the worksheets, please fill it out in detail. In addition, a copy of the potential patient’s insurance card (front and back) needs to be made.
  3. When the worksheets are completed and a copy of the insurance card is available please fax all documents to the Intake department at 612-273-4461.
  4. When the Intake department has received all the pertinent information they will forward it on to the Deaf and Hard of Hearing (DHOH) Program.
  5. The DHOH Program staff will be in contact with either you or the potential client to continue the admission process.

Additional Information:

  1. Admission dates and times are determined by the program staff with consideration to the client’s needs and the ability of the program to accommodate the potential client.
  2. Some types of funding may require patients to make a down payment at the time of admission. Flexible payment plans for self-pay clients and costs not covered by insurance are available.
  3. If the potential client is admitted, the DHOH program staff will provide him/her with all necessary information (where we are located, what to bring, etc.).
  4. Transportation: A round trip ticket may be required for admission. It is very important not to book transportation until all arrangements have been finalized and approved by our office.  Note: Any change made to a transportation ticket is the client’s responsibility.
  5. We are happy to keep family members and referral sources informed, but please understand that we are unable to discuss client progress until the appropriate Release of Information form has been signed by the client.