Get Ct Cbha Therapy Verification Form

The CT CBHA Therapy Verification Form is an essential document for individuals receiving therapy for substance addiction. This guide provides detailed instructions on how to complete the form online, ensuring a smooth and accurate submission process.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to access the form and open it in the designated editor.
2. Fill in the client name, date, and date of birth in the corresponding fields to provide identification details.
3. Enter the telephone number and the individual’s name who is completing the form before specifying the agency involved.
4. Complete the licensed professional therapist information section by selecting the appropriate license type and entering their contact information.
5. Indicate whether substance addiction is the primary focus of treatment by selecting 'YES' or 'NO'.
6. Confirm if the client has a treatment plan with identified goals for substance addiction recovery by marking 'YES' or 'NO'.
7. List the scheduled appointment dates in the provided space and ensure to document attendance by initialing next to each date attended.
8. In the signatures section, ensure the client, licensed therapist, CBHA coordinator, and CBHA psychiatrist sign and print their names, along with the respective dates.
9. After all fields are completed, review the form for accuracy, then save your changes. You may download, print, or share the form as needed.

Complete your CT CBHA Therapy Verification Form online today and ensure your therapy documentation is accurately submitted.