MAIN OFFICE

80 Conover Rd.
Marlboro, NJ 07746
800-705-HOPE (4673)

48 Hour IDRC Telehealth Forms

Please complete all forms as fully as possible.  If you would like to receive a copy of the forms you must include your email address.  

IDRC Curriculum Manual can be downloaded HERE

FORMS – You will NOT be registered for the class unless you submit forms 1 though 6. DO NOT FILL OUT FORMS 7 THROUGH 9.

      1. SSI for Alcohol and Other Drugs
      2. Autobiographical Statement
      3. Autobiography
      4. Attestation
      5. Informed Consent for Telehealth Services
      6. New Jersey DUI/Refusal Legal Requirements
      7. IDRC Records Release Authorization
      8. IDRC Agreement to Schedule
      9. IDRC Client Selection of Affiliate

Provider Lists by County

Monmouth County Provider List
Middlesex County Provider List
Ocean County Provider List
Camden County Provider List
Mercer County Provider List
Cape May County Provider List
Burlington County Provider List

 

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