Get Mclean At Naukeag Ambulatory Treatment Program Self-refferral Packet 2016-2025

Filling out the McLean at Naukeag Ambulatory Treatment Program Self-Referral Packet is an important step in seeking treatment. This guide provides a detailed, step-by-step approach to help you complete the form accurately online, ensuring your application is submitted successfully.

Follow the steps to complete your self-referral application conveniently online.

1. Click the ‘Get Form’ button to access the Self-Referral Packet and open it in your preferred document editor.
2. Begin by providing your personal information in the 'Patient Information' section. This includes your name, age, gender, date of birth, address, email, and phone numbers. Additionally, indicate how you heard about Naukeag.
3. Answer whether you have previously visited Naukeag and if you are being referred by any treatment provider. If yes, provide their name.
4. In the 'Presenting Problem' section, check all the boxes that reflect the issues you are currently experiencing. Additionally, write a brief statement explaining your reasons for seeking admission.
5. Navigate to the 'Current Treatment' section. Indicate whether you have any current treatment providers and provide their names and contact details. Make sure to disclose any psychiatric diagnoses.
6. Fill out the 'Past Treatment' section by listing any previous treatments you have undergone, along with the facility names and dates.
7. In the 'Drug Use History' section, document your primary and secondary drugs of choice, any relevant usage details, and medication information.
8. Detail any current medical conditions, list your medications, and indicate your healthcare provider's information.
9. Report any risk factors, including suicide attempts, self-harm history, and trauma.
10. Complete the 'Legal' section by mentioning any current legal charges, probation status, or restraining orders.
11. Outline your aftercare plans and potential housing after treatment, indicating preferences such as returning home or seeking a sober house.
12. Provide any additional comments you deem necessary in the comments section.
13. Once you have completed the form, save your changes. You can then download, print, or share the form as needed. If applicable, fax the completed application to the provided number and call within 48 hours for follow-up.

Take the first step towards your recovery by completing the McLean at Naukeag Ambulatory Treatment Program Self-Referral Packet online today.