Get Referral List Verification Form (pdf)

Filling out the Referral List Verification Form online provides a streamlined way for users to confirm their understanding of licensed DUI and/or substance abuse treatment programs. This guide will walk you through the necessary steps to complete the form efficiently and accurately.

Follow the steps to fill out the Referral List Verification Form online.

1. Click the ‘Get Form’ button to access the form and open it in your preferred PDF editor.
2. Locate the 'Offender Signature' field. Here, the user must provide their signature to indicate acknowledgment of the options available for treatment programs.
3. Next, find the 'Date' field next to 'Offender Signature.' Enter the current date to document when the form is being filled out.
4. Proceed to the 'Evaluator Signature' field. This section requires a signature from the evaluator who provided the referral list, confirming their role in the process.
5. Afterward, complete the 'Date' field next to 'Evaluator Signature' with the date when the evaluator signs the form.
6. Review the completed form for accuracy. Make sure all fields are filled in correctly and that signatures are present.
7. Finally, save your changes, and choose to download, print, or share the completed form as needed.

Complete your Referral List Verification Form online today for a seamless experience.