Online Referral Form

Our Office Address:

528 Bridge St. NW #3
Grand Rapids, MI. 49504
Phone: 616-774-7002
Fax: 616-774-7007

or

177 S Main Street
Wayland, MI 49010
Phone: 616-774-7002
Fax: 616-774-7007

Office Hours
10am-5pm
Monday through Friday
Additional hours by appointment
Closed Holidays.

Payment is expected at time of service unless other arrangements are made in advance with Journies.

Journies is located to the southeast corner of Bridge and Steward in the Bridge Street Depot. Rapid Bus Line - #9 or #18

Please fill out the following information

Referred By:

Client's Name: (required)

Your Phone Number (required)

Your Email (required)

Address

Street:

City:

State:

Zipcode:

Convicted of:

BAC:

Reason for Referral

Assessment - $90Urine Test - THC or Cocaine - $10Urine Test 4-Panel Screen - $30Intensive Outpatient - $700Drivers License Assessment - $175/$200Individual Sessions - $60Crossroads Group - $350First Offenders Group - $90Relapse Prevention Group - $30Allegan Group - $225Relapse Prevention - Wayland - $30 per sessionOther

Other Information