Referral Letter


Please use the following guidelines to write your referral letter

 

Readiness for Healing Program:

A – Present emotional health

B – Why now?

C – Previous Treatment or Healing Program?

Alcohol and Drug History

Relationships

What resources does Applicant have?

Healing Program Goals?

Referred by:

Name:

Address:

Telephone:

Relationship to Applicant:

  • Employer
  • Counsellor
  • A.A., Sponsor
  • Physician
  • Probation Officer
  • Other (Specify)