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Approved: Yes / No Signature: ___ Bed Date: ___SERENITY HOUSE REFERRAL FORM NAME:DATE:SSN:DOB:ADDRESS: PHONE: COUNTY OF RESIDENCE: REFERRAL SOURCE: REFERRAL SOURCE PHONE # ___ IS TREATMENT COURT ORDERED?

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How to fill out serenity house referral form

01

Obtain a copy of the Serenity House referral form.

02

Fill out your personal information accurately, including your full name, contact information, and any relevant medical history.

03

Provide information about your current living situation and the reason for seeking assistance from Serenity House.

04

Include any supporting documentation or relevant information that may help in the intake process.

05

Submit the completed referral form to Serenity House through their designated channels.

Who needs serenity house referral form?

01

Individuals seeking assistance with substance abuse or mental health issues.

02

Referral agents working with clients in need of residential treatment services.

03

Healthcare professionals recommending clients for residential care at Serenity House.

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What is serenity house referral form?

The serenity house referral form is a document used to refer individuals to Serenity House for assistance with addiction recovery services.

Who is required to file serenity house referral form?

Anyone seeking assistance with addiction recovery services from Serenity House may be required to file a referral form.

How to fill out serenity house referral form?

To fill out the serenity house referral form, individuals must provide personal information, details about their addiction history, and reasons for seeking assistance.

What is the purpose of serenity house referral form?

The purpose of the serenity house referral form is to gather information about individuals seeking assistance with addiction recovery services to determine the best course of action for their treatment.

What information must be reported on serenity house referral form?

Information such as personal details, addiction history, reasons for seeking assistance, and any previous treatment experiences must be reported on the serenity house referral form.

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