Get Application For Services - Sara Riel Inc

Filling out the Application For Services for Sara Riel Inc online is a straightforward process designed to ensure that users receive the necessary support in an effective manner. This guide provides step-by-step instructions to assist you in completing the application accurately and efficiently.

Follow the steps to fill out the Application For Services online.

1. Click the ‘Get Form’ button to access the application form and open it in your designated editor.
2. Begin by providing your personal information. Fill in your first name, initial(s), last name, telephone, cell/alternate, email, and date of birth in the specified format (mm/dd/yyyy). Also, indicate your sex and marital status.
3. Next, input your address information including your complete address, city/town, province, postal code, and the date you have been at this address.
4. In the ethnicity section, specify your citizenship status, preferred language, and functional languages. If applicable, provide information regarding First Nations ancestry.
5. Indicate your referral source. If someone referred you to Sara Riel, fill out their name, title, organization/agency, and include their signature and the date.
6. Select the services you are interested in applying for from the options provided. Complete any additional fields regarding specific activities or topics of interest.
7. In the assessment information section, check any applicable mental health diagnoses, and indicate whether you have concurrent diagnoses or disabilities.
8. List medications you are currently prescribed along with their dosages, and provide information regarding medication compliance.
9. Address any addictions by indicating current involvements you may have with substances or behaviors listed.
10. Complete the legal section by indicating any legal involvement you may have and any history with the criminal justice system.
11. Provide information about your education background, employment status, and current sources of income, selecting all that apply.
12. Indicate any mental health services you have used in the past year and specify any other services you are currently receiving.
13. Fill in the emergency contact information, providing the person's name, relationship, telephone number, and address. Ensure they understand that they may be contacted in emergencies.
14. Complete the key service providers section, providing names, contacts, and any pertinent details related to your healthcare providers.
15. Finally, read and sign the authorization for the release of information. Ensure all information is accurate before saving your completed application. You may then choose to save changes, download, print, or share the form as needed.

Complete your application for services online today to access the support you need.