Get Referral Form - The Camelot Difference

Completing the Referral Form - The Camelot Difference online is a straightforward process that helps streamline the referral for various services. This guide will walk you through each section of the form to ensure that all necessary information is accurately provided.

Follow the steps to effectively complete the Referral Form online.

1. Press the ‘Get Form’ button to access the Referral Form and open it in the editor. This will allow you to begin filling out the necessary details.
2. Enter the date in the appropriate field at the top of the form. This information helps to record when the referral is made.
3. Fill in the referral agency or name section with the name of the agency or individual making the referral.
4. Provide the email address and phone number of the referral source. Ensure that all contact information is correct to facilitate communication.
5. Select one of the provided options by checking the relevant box to indicate the type of service being referred, such as Intensive In Home or Outpatient services.
6. Complete the personal details section by entering the name, date of birth, sex, and social security number of the individual being referred.
7. Identify the race and primary language of the individual, as this information can be essential for appropriate service provision.
8. Fill in the address, including the apartment number (if applicable), city, state, zip code, and county to ensure accurate location details.
9. If applicable, include the parent or guardian's name and their contact phone number for referrals involving minors.
10. Indicate the insurance company details, if any, and check whether the payment will be self-pay or through another source.
11. Provide a detailed description of the current situation and behaviors that have led to this referral, which is important for assessment.
12. Once all required fields are completed, save your changes. You can also download, print, or share the form as necessary.

Complete the Referral Form - The Camelot Difference online today to ensure timely assistance.