Referral Packet Request
A complete Referral Packet must contain all of the following items:
Referral Checklist & Questionnaire (links below or use the form on this page)
Individual Service Plan (ISP) / Treatment Plan (for SMI clients). Needs to include the verbiage Peer Support (this will cover both individual and groups), Skills Training (this will cover both individual and groups), Transportation - Nonemergency (A0120 and S0215). Signed and dated by Member, Staff, and BHP (or include Affidavit)
Assessment - Must cover ISP dates of service. Signed and dated by Staff or include Affidavit.
Release of Information (Health Home to Hope Lives)
Who can submit a Referral?
Members (self)
Clinic Case Managers
Hospital/Therapist Offices
Other Peer & Family Organizations
Hope Lives Employees
The Hope Lives Referral Forms can be found here:
Please print out and fax completed referrals to 602-388-1567 or one of the following contacts below. You may also complete the online form on this page.
Phoenix: referrals@vivehopelives.org
Flagstaff: northreferrals@vivehopelives.org
Kingman: mohavereferrals@vivehopelives.org
Hope Lives will notify the member and referring party (if different) when they are eligible to start attending.