Get the free REFERRAL FORM - Addiction Services of Thames Valley - adstv on

REFERRAL From The following referral form is intended for London Health Sciences Center staff who wish to refer a client to Addiction services of Thames Valley. Once completed, please fax to 5196731022.

How to fill out referral form - addiction

How to fill out referral form - addiction:

1. Obtain the referral form from the appropriate source, such as a medical facility or addiction treatment center.
2. Fill out your personal information accurately, including your full name, contact information, and date of birth.
3. Provide details about your addiction, including the substance or behavior you are struggling with and the duration of the addiction.
4. Include any relevant medical information, such as existing health conditions or medications you are currently taking.
5. Specify your preferred method of contact for further communication.
6. If applicable, provide information about your insurance coverage or financial arrangements for treatment.
7. Sign and date the referral form to indicate that all the information provided is true and accurate.
8. Submit the completed referral form to the appropriate recipient, whether it's a healthcare professional or treatment center.

Who needs referral form - addiction:

1. Individuals seeking professional help for their addiction can benefit from a referral form. Whether it's for substance abuse, gambling addiction, or any other addictive behavior, a referral form can connect individuals with the necessary resources to begin their journey towards recovery.
2. Healthcare professionals, such as doctors, psychiatrists, or therapists, may require a referral form to understand the individual's history, background, and current situation related to addiction. This information helps them assess the severity of the addiction and determine the most appropriate treatment plan.
3. Addiction treatment centers or facilities often require a referral form to ensure that individuals seeking admission meet the necessary criteria for admission. This form helps streamline the intake process and ensures that individuals receive the appropriate level of care for their addiction.

Remember, the specific requirements for filling out a referral form may vary depending on the provider or facility. It's essential to carefully read the instructions provided with the form and provide accurate and honest information to facilitate the referral process.

For pdfFiller’s FAQs

What is referral form - addiction?

Referral form - addiction is a form used to refer individuals struggling with addiction to appropriate treatment and support services.

Who is required to file referral form - addiction?

Healthcare professionals, social workers, and other relevant professionals are required to file referral form - addiction.

How to fill out referral form - addiction?

Referral form - addiction can be filled out by providing detailed information about the individual's addiction history, current treatment needs, and contact information.

What is the purpose of referral form - addiction?

The purpose of referral form - addiction is to ensure that individuals struggling with addiction receive the necessary support and treatment to overcome their addiction.

What information must be reported on referral form - addiction?

Information such as the individual's addiction history, treatment needs, current challenges, and contact information must be reported on referral form - addiction.

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