Referral Form

We welcome referrals from treatment centers, case managers, social workers, and community partners who are supporting individuals in early recovery. New Vine Living offers structured, supportive housing for adult men in Manchester, CT.

If you know someone who would benefit from a stable and accountable living environment, please complete the referral form below. Our team will follow up promptly to begin the intake process and ensure a smooth transition.

For questions or additional information, feel free to contact us directly.

Please indicate your role in completing this referral form.

Name

First Name

Last Name

Company Name

Phone

Country

(###)

###

####

Email

Client's First and Last Name

First Name

Last Name

Client's Phone Number

Country

(###)

###

####

Desired Move in Date

MM

DD

YYYY

Disclaimer

Please note that completing this referral form does not guarantee acceptance into New Vine Living. All referrals are subject to review by New Vine Living management to ensure appropriate fit and readiness for our program. We will follow up after reviewing the submitted information.

I understand and agree

I do not agree

Referral Form

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