Refer a Patient To refer a patient to Northstar Regional, fill out the form below. Please send all accompanying documentation to admissions@northstarregional.com. Refer a Patient To refer a patient to Northstar Regional, fill out the form below. Please send all accompanying documents to admissions@northstarregional.com. Referent Name* First Last Referent Organization*Referent Phone*Referent Email* Referent Street Address Street Address Address Line 2 City State ZIP / Postal Code Patient Name* First Last Patient Phone*Insurance TypeService(s)* Chemical Dependency Mental Health Has a Rule 25 Assessment been completed?* Yes No Reason for Service Please send all accompanying documentation to admissions@northstarregional.com.EmailThis field is for validation purposes and should be left unchanged.