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FTC Referral Form

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Steps

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

  • Step One

    2. Douglas County Georgia
    3. Douglas County Family Treatment Court Referral
    5. PLEASE COMPLETE ALL BLANKS & USE ONE FORM PER CLIENT
    10. your name
    16. Use NA if not available
    17. Choose one
    28. Pregnant:*
    29. Married:*
    33. Please explain
    36. Have you referred client for substance use assessment prior to this referral?*
    44. Employed?*