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

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