Get Common Actt Referral Form - Ontario Shores Centre For

Filling out the Common ACTT Referral Form is a key component in accessing essential mental health services. This guide provides clear, step-by-step instructions to assist you in completing the form accurately and efficiently.

Follow the steps to complete your form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. Begin with Section A, Personal and Contact Information. Fill in the applicant’s first name, last name, street address, apartment number, entry code, telephone number, city, province, and postal code. If the applicant does not have a fixed address, provide a possible location where they might be found.
3. Continue with the contact options. If the applicant is difficult to reach, provide the name and phone number of someone who can be contacted on their behalf, including their relationship to the applicant.
4. Indicate whether the applicant has a Substitute Decision-Maker, Trustee for finances, or Power of Attorney, providing the necessary contact information for each if applicable.
5. Specify the date of birth and gender of the applicant. If the applicant has an Ontario Health Card, include that number.
6. Inquire about the applicant’s language preferences and ethnicity. These questions are optional but can help tailor services effectively.
7. Proceed to Section B, Referral Source Information, and complete the details such as the referrer’s name and agency, their contact information, and the relationship to the applicant.
8. In Section C, Current Status, detail who the applicant currently lives with, their housing situation, primary source of income, employment status, and educational history.
9. In Section D, Health Information, specify the applicant’s mental health history, current mental health diagnosis, and treatment history.
10. In Section E, Applicant's Support Needs, identify the assistance the applicant is requesting and provide comments regarding their support needs.
11. For Sections F and G, Existing and Past Supports, detail any current or previous service providers and informal supports assisting the applicant.
12. Section H requires any supporting documentation to be listed. Ensure that all requested documents are gathered for submission.
13. Complete the declaration and consent section, ensuring the necessary signatures are included, although the applicant's signature is not mandatory.
14. After verifying all information, save the changes in your document, and then download, print, or share the completed form as required.

Ensure your application is complete by following these steps and submit the documents online for a timely review.