Get the free DBT Eastside Referral Form 1 1400 112th Ave SE, Suite 202, Bellevue, WA 98004 * 425

DEBT Eastside Referral Form 1 1400 112th Ave SE, Suite 202, Bellevue, WA 98004 425.615.0605 Fax: 425.454.2541 Date: Referred By: Client Name: Age: Male:

How to fill out dbt eastside referral form

How to fill out the DBT Eastside referral form:

1. Start by downloading the DBT Eastside referral form from their official website or obtain a physical copy from their office.
2. Begin filling out the form by providing your personal information such as your full name, contact details, and address.
3. Include your date of birth, gender, and any relevant medical or mental health history that would be useful for the referral process.
4. The form may require you to provide information about your current insurance coverage or financial information for billing purposes.
5. Indicate the reason for your referral to DBT Eastside, whether it is for individual therapy, group therapy, or any other specific program they offer.
6. Fill out any checkboxes or sections related to the specific services you are seeking, such as Dialectical Behavior Therapy (DBT) or other specialized treatment approaches.
7. If you have a specific therapist or provider in mind, make sure to mention their name on the form, if applicable.
8. Provide any additional information, such as emergency contact details or any specific concerns or preferences you may have.
9. Review the completed form to ensure all the necessary information is provided and accurate.
10. Once you are satisfied with the form, submit it according to the instructions provided by DBT Eastside.

Who needs the DBT Eastside referral form?

1. Individuals seeking specialized mental health treatment: The DBT Eastside referral form is needed by individuals who are specifically interested in receiving Dialectical Behavior Therapy and related services offered by DBT Eastside.
2. Those diagnosed with mental health conditions: This form is typically required from individuals who have already been diagnosed with mental health conditions such as borderline personality disorder, depression, anxiety disorders, or mood disorders and are seeking appropriate treatment.
3. Individuals in need of therapy or group support: Those who feel they can benefit from therapy or therapeutic group settings to improve their emotional well-being and develop coping skills may need to fill out the referral form.

Remember, it's always advisable to contact DBT Eastside directly for accurate and up-to-date instructions on how to fill out their specific referral form and to ensure that you meet their criteria for treatment.

For pdfFiller’s FAQs

What is dbt eastside referral form?

The dbt eastside referral form is a document used to refer individuals to Dialectical Behavior Therapy (DBT) services on the eastside.

Who is required to file dbt eastside referral form?

Healthcare providers, therapists, or individuals seeking DBT services are required to file the dbt eastside referral form.

How to fill out dbt eastside referral form?

To fill out the dbt eastside referral form, one must provide information about the individual needing DBT services and contact details of the referring party.

What is the purpose of dbt eastside referral form?

The purpose of the dbt eastside referral form is to facilitate the referral process for individuals in need of DBT services on the eastside.

What information must be reported on dbt eastside referral form?

The dbt eastside referral form must include the individual's name, contact information, reason for referral, and any relevant medical history.

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