48 Hour IDRC Telehealth Forms

NOTICE: Beginning 4/1/2023 a 3% surcharge will be added on all credit card payments.  If you prefer not to pay by credit card you can use a certified check or money order. 

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 5. DO NOT FILL OUT FORMS 6 THROUGH 8.

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

Provider Lists by County

Atlantic County Provider List
Bergen County Provider List
Burlington County Provider List
Camden County Provider List
Cape May County Provider List
Cumberland Co Provider List
Essex County Provider List
Gloucester County Provider List
Hudson County Provider List
Hunterdon County Provider List
Mercer County Provider List
Middlesex County Provider List
Middlesex County Provider List – Spanish
Monmouth County Provider List
Morris County Provider List
Ocean County Provider List
Passaic County Provider List
Salem Co Provider List
Somerset Co Provider List
Sussex Co Provider List
Union Co Provider List
Warren County Provider List