Alcohol & Drug Treatment Referral Form
Form Template
The Alcohol & Drug Treatment Form mobile app is an easy to use referral form for patients being referred to your treatment center for programs related to substance abuse, drug addiction, drug rehab, and other addiction related problems.
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Basic information is included for patient/client address, or guardian details if the patient or client is a minor, as well as the type of billing. Referral service information is also gathered, including a reason for referral.
The form also allows for electronic signature and date by both the referrer and patient or guardian, and can include information and details of addresses for different treatment centers.
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