DART Referral

If this is a life threatening Emergency or crisis, please call 9-1-1.

This form is to be used to submit a Referral to DART, the Drug Addiction Recovery Team. A Community Responder will reach out to the person being referred within 72 hours.

You may also reach us by telephone or text at 413-588-2335.

To Continue, please complete the form below and click submit.

Person Making Referral

All submitter's information is confidential and is not shared with any parties. If you are not the Person Making the Referral, and have any follow-up or questions, you will need to contact us by telephone at 413-588-2335.

Role of Person Making Referral (if Not Self) (required)

Person Making Referral- First Name

Person Making Referral- Last Name (required)

Person Making Referral- Preferred Phone Number

Person Making Referral- Email

Person Being Referred

Person being Referred - First Name

Person being Referred - Last Name (required)

Alias/Nickname

Street Address

Unit/Suite

City

State

Zip Code

Preferred Phone Number (required)

Date of Birth

Gender

If Other, Identifies as

English Speaking

Primary Language

If Other language

Hispanic/Latino/a

Race

If Other Race

Pronouns

Other Pronoun

Veteran Status

Does this individual need support with housing or access to a shelter?