80 Conover Rd.
Marlboro, NJ 07746

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.  

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. 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

      Spanish Forms

      1. SSI para alcohol y otras drogas – Spanish
      2. Declaración Autobiográfica – Spanish
      3. Autobiographa – Spanish
      4. Attestation – Spanish (Teestimonio Del Cliente)
      5. Requisitos Legales de Rechazo de NJDUI-48 – Spanish
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