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Click ‘Get Form’ to open the Screening Application in the editor.
Begin by selecting your Program of Interest from the options provided: Domiciliary Care for Homeless Veterans, Substance Abuse Residential Treatment, or Post Traumatic Stress Disorder Treatment.
Fill in your personal information including Date, Name/Address, SSN, Date of Birth, and Phone number. Ensure accuracy for effective processing.
In the Chief Complaint section, describe the issues prompting you to seek treatment. Be as detailed as possible to help staff understand your needs.
Indicate your treatment goals and list your strengths, needs, abilities, and interests in the respective sections to provide a comprehensive view of your situation.
Check all applicable symptoms/problems from the list provided. This helps in assessing your current mental health status.
Complete sections on Medical History, Education/Employment, Legal History, Military History, Family/Social History, and Homeless Screen with accurate details.
Review all entries for completeness and accuracy before submitting. Use our platform’s features to save or print a copy for your records.
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