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Drug Addiction Counseling Referral: Google Form Template

Drug Addiction Counseling Referral Form

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

You may see this is how the form looks :


Description of Drug Addiction Counseling Referral Form

This form has seven section. First section in this form expects you to write your Name.

Next section you to supply your phone number.

Next section expects you to write your Email.

Next section expects you to write Student's Name

Next section you to supply Student Age.

Next section expects you to write your Relationship with Student.

Last section expected to mention brief description of student's drug addiction history.

Complete the Drug Addiction Counseling Referral and click submit.

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