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Get the free Peer Recovery Coach Referral Form

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This form is used to refer clients to a peer recovery coach. It collects necessary client information including personal details, treatment status, assistance needs, and contact information.
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How to fill out peer recovery coach referral

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How to fill out peer recovery coach referral

01
Start by gathering necessary information about the individual requesting the referral.
02
Complete the referral form with the individual's personal details, including name, contact information, and date of birth.
03
Specify the reason for the referral, focusing on the individual's specific needs and circumstances.
04
Provide information on any previous recovery efforts or relevant history that may assist the peer recovery coach.
05
Include any additional support or resources that may be beneficial for the individual.
06
Sign and date the referral form before submitting it to the appropriate peer recovery coach.

Who needs peer recovery coach referral?

01
Individuals struggling with substance use disorders who are seeking support in their recovery journey.
02
People looking for guidance and motivation from someone with lived experience in recovery.
03
Those who may benefit from coordinated support and resources to maintain sobriety.
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A peer recovery coach referral is a process through which individuals seeking recovery from substance use disorders are connected with trained peer recovery coaches who provide support and guidance based on their own experiences.
Healthcare providers, addiction treatment facilities, and organizations that offer recovery services are typically required to file peer recovery coach referrals for individuals in recovery.
To fill out a peer recovery coach referral, provide the individual's personal information, details of their substance use history, goals for recovery, and any specific needs or preferences related to coaching.
The purpose of peer recovery coach referral is to facilitate access to recovery support services, enhance the recovery process, and ensure individuals have the necessary resources and guidance to achieve long-term sobriety.
Required information on a peer recovery coach referral typically includes the individual’s name, contact information, substance use history, treatment history, desired goals, and the referring provider's details.
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Peer Recovery Coach Referral Form Substance Abuse Recovery Support Client Information Treatment Options Assistance Needs Mental Health Emotional Wellness Recovery Resources

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