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216-505-6936
iTreatment & Recovery Services
Referral Short Form
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A thorough assessment is important as it can provide your counselor with helpful information about your background and because most insurance policies and other third-party payers require that counselors collect this information.
We ask that you start this simple form which allows our counselors to spend time in a session focusing on what is most important to you.
​Submitting this completed form will begin the process!
Join the Program and Rediscover Your Confidence
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