We have three convenient ways for you to send a referral.

     1. Use our secure on-line-referral by clicking on the appropriate state of your claim on the MAP below
                      If you do not see your state please use our generic Referral Form.
                                            For help you can email or call 1-866-390-4005 for customer support

       For National TCM and Multicultural Products Click here
                            

2. Print out our referral form and fax it toll free to 1-866-649-5889

Please select a State Select Form Generic State Form Illinois Iowa Kansas Michigan Minnesota Missouri Nebraska Nevada North Dakota South Dakota Wisconsin National TCM and Multicultural    Microsoft Word Required                                      click "Open" when the dialog box comes up

  3. Contact Lanette Elder with your referral request:

Lanette M. Elder
lanette.elder@alarisgroup.com

P O Box 298
Savage MN 55378
Office 1-952-226-4562
Toll Free 1-877-259-4588
Fax 1-866-283-0290
Mobile 1-612-710-4426