Cloud Cloud Cloud Cloud

Substance Use Disorder Counseling Referral

Hi, friend! Sign up or sign in to Wufoo to use this form. Not what you're looking for? We've got 400+ templates to choose from.

Substance use disorder is one of the greatest concerns in our society today - especially among students. Share our online Substance Use Disorder Counseling Referral with your staff and student body so that they can refer fellow students who they believe have or are in danger of suffering from addiction. Provide prompt and appropriate guidance and counseling - or if necessary, referral to a rehab center for more in-depth treatment. Our online form can be fully customized to meet the particular needs of your school or student body.

What's in the Substance Use Disorder Counseling Referral?

Launch this form as-is or customize it to your heart's content!

Use This Form

Whether you are a school administrator, school psychologist, school counselor, or school teacher, you have probably witnessed the damage that substance use disorder can have on your students and their families. Use our online Substance Use Disorder Counseling Referral template to solicit referrals regarding students that may be struggling with addiction. Collect the name of the referring party, their contact information, and the referred student's name and age. Get a full description of the addiction history and/or specific concerns. Swift action can make all the difference in a student's life!

Trusted by some of the most popular brands on the web.

Pterosaur Cloud Cloud Cloud

Let's make it official

We want to give you our everything (and more if you need it).

Not ready to commit? Try before you buy.

Create a Wufoo account today and build 5 forms for FREE >

Our Cookie Policy and Privacy Policy outline how we use cookies to help optimize service, personalize content, tailor and measure our marketing, and improve your user experience. I agree to use of cookies for these purposes.