This form is for external referrals for participants seeking support from a Certified Recovery Mentor at The Equi Institute in the Recovery Support and Harm Reduction Program.
Please note that not all questions are required, or there are options for non-disclosure. Individuals are supported in answering to the degree of their comfort level. We believe in moving at the speed of trust. Self-disclosure on personal matters is up to the participant.
If the referring provider or organization is providing any past or current services to the client, please include a Release of Information (ROI) form to aid continuity of care. (Reach out to The Equi Institute for access to a form if you have not already been sent an ROI.)
If you have any questions, please contact info@equi-institute.org or 503-459-2584.