Get Casa Referral

Filling out the Casa Referral form is an essential step for accessing mental health services for children and adolescents. This guide will provide detailed instructions to help you complete the form accurately and efficiently, ensuring that the necessary information is collected for a successful referral.

Follow the steps to fill out the Casa Referral form correctly.

1. Press the ‘Get Form’ button to access the Casa Referral form and open it in the designated editor.
2. Begin by selecting the program for which the child is being referred: either the Concurrent Addiction & Mental Health Program (CAMP) or FAS TRACS. Make sure to check the appropriate box.
3. Fill in the child's full legal name, including last name, first name, and middle name.
4. Enter the Alberta Health Care Number, which is a mandatory field.
5. Provide the child's date of birth in the Day-Month-Year format and record their age.
6. Indicate the child's gender by circling the appropriate options: Male, Female, or Transgender.
7. Complete the child's current address by including the street address, city, and postal code.
8. Provide information about the parent(s) or guardian(s). Include full names and circle the appropriate descriptors (e.g., Biological, Adoptive, Step, etc.).
9. List the family status and contact details such as home and alternate phone numbers.
10. Indicate who has legal custody of the child and provide any legal documentation if applicable.
11. Fill in the referral information, including who referred the child to CASA and their contact details.
12. Articulate specific concerns regarding the child's emotional well-being, home situation, school environment, and community involvement.
13. Answer questions regarding substance use, activities of concern, and any history of abuse or traumatic events.
14. If applicable, fill out the additional information required for the FAS TRACS program, including birth history and developmental concerns.
15. Sign and date the form. Ensure that all required guardianship signatures are included, especially if legal authorities are involved.
16. Finally, review the completed form for accuracy. You can save changes, download, print, or share the form as necessary.

Complete the Casa Referral form online today to initiate access to essential mental health services.