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FTC Referral Form

Steps

  1. 1. Step One
  2. 2. Child(ren) name(s) and DOB(s)
  • Step One

    1. Douglas County Georgia

    2. Douglas County Family Treatment Court Referral

    3. PLEASE COMPLETE ALL BLANKS & USE ONE FORM PER CLIENT

    4. your name

    5. Use NA if not available

    6. Pregnant:*

    7. Married:*

    8. Please explain

    9. Have you referred client for substance use assessment prior to this referral?*

    10. Employed?*