Get Phoenix Center Adol 014 2021-2025

Navigating the Phoenix Center ADOL 014 form can be straightforward with the right guidance. This guide provides clear, step-by-step instructions to help users effectively complete the online form, ensuring all necessary information is submitted accurately.

Follow the steps to successfully fill out the form

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by entering the date of referral. This indicates when the referral is being made.
3. Provide the client’s name in the designated field to identify the individual receiving the referral.
4. Input the client's Social Security Number (SS#) as required.
5. Fill in the parent or guardian's name. This identifies the legal guardian of the client.
6. Enter the parent or guardian's phone number for contact purposes.
7. Specify the referring agency to provide context of the referral source.
8. List the referring agent's name and phone number to facilitate follow-up communication.
9. Clearly state the reason for the referral to inform the services needed.
10. If applicable, note any pending charges that may influence the assessment.
11. Indicate if the referral is court-ordered by checking 'Yes' or 'No'. If 'Yes', be sure to attach a copy of the court order.
12. Fill in the date of birth of the client to establish their age and eligibility for services.
13. Check the appropriate boxes for recommended services required for the client.
14. Complete the address field with the client’s current address.
15. Schedule the appointment by noting the desired date and remember to call the center to confirm.
16. List all required documents that need to be brought to the appointment, including photo identification and insurance cards.
17. If selecting a drug screen, specify the type needed and provide the fee amount.
18. Finalize by saving the changes, and then download, print, or share the form as necessary.

Ensure you complete all necessary documents online for a seamless referral process.