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Please complete and sign the following documents before faxing email the Referral Admissions Packet

Please complete and sign the following documents before faxing email the Referral Admissions Packet 2026

Please complete and sign the following documents before faxing email the Referral Admissions Packet Preview on Page 1

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The document is a Referral/Admission Packet for Fairview Recovery Services, Inc., which provides rehabilitation services for individuals dealing with alcoholism, chemical dependency, and co-occurring conditions. It outlines the application process, required documentation, and guidelines for living at the facility. The packet includes checklists for applicants, consent forms for health information sharing, and detailed rules and regulations that clients must adhere to during their stay to ensure a safe and supportive recovery environment.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'Applicant Information' section. Provide your name, phone number, and address. Ensure all details are accurate.
Complete the 'Veteran Status' section if applicable. Indicate whether you are a veteran and provide additional details as required.
In the 'Substance History' section, check 'Yes' or 'No' regarding any substance use disorder diagnosis and provide relevant details if applicable.
Fill out the 'Treatment History' and 'Mental Health' sections with accurate information about previous treatments and mental health diagnoses.
Review all sections for completeness. Use our platform's features to add signatures where required before saving your document.
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