Get Odyssey House Referral Form - Gibaultodyssey

Filling out the Odyssey House Referral Form - Gibaultodyssey is a crucial step for individuals seeking assistance. This guide provides clear instructions to help you navigate the process effectively and accurately.

Follow the steps to complete the referral form online.

1. Click the ‘Get Form’ button to access the referral form and open it in the editing platform.
2. Begin by entering the date at the top of the form. This helps establish the timeline for your referral.
3. In the 'Name' field, provide your full name as it appears on legal identification documents.
4. Fill out your date of birth in the specified format (MM/DD/YYYY) to verify your age.
5. Indicate your race. This information is often required for demographic purposes.
6. Provide your current address, including street address, city, and state. Ensure this information is accurate to facilitate communication.
7. Fill in the referring agency representative's name, along with their telephone number and email address for follow-up communication.
8. Under the medical information section, disclose how long you have been sober. This helps the agency understand your current status.
9. Specify your drug of choice. This is important for tailoring your treatment needs.
10. List any medical conditions you have, including both chronic and acute issues.
11. Detail any previous or current mental health issues to inform the treatment team of your psychological background.
12. In the general information section, answer whether you have lived in a sober house before.
13. List any drug treatment or classes you have previously attended, emphasizing your recovery journey.
14. Indicate which recovery meetings you regularly attend (e.g., AA, NA, RA, etc.).
15. Answer if you are a veteran. This may influence the type of support and resources available to you.
16. State if you have any pending charges and include your past convictions, as this context is crucial for your case.
17. Note whether you have ever been convicted as a sex offender, which is a significant detail for the referral.
18. Confirm your current employment status by indicating whether you are employed.
19. If applicable, specify if you have children, as this may impact your treatment considerations.
20. Indicate your probation or parole status, specifying where you are serving it.
21. Include your salary on a weekly or monthly basis to provide an overview of your financial situation.
22. State if you pay child support and mention the amount.
23. Once all fields are filled out, review your entries for accuracy. Then, save your changes, and choose to download, print, or share the completed form as needed.

Complete the Odyssey House Referral Form - Gibaultodyssey online now to seek the support you need.