The primary purpose of these assessment packages is for client referral to Wilp Si’Satxw Community Healing Centre. The assessment package may also be used for referring a client to another type of agency other than a treatment Centre as it is consistent with the information collected for other National Native Alcohol & Drug Abuse Program funded treatment centres.

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Please download and fill out the appropriate form with your client, then email it to our intake person at referrals@wilpchc.ca. Alternatively, you can print the form and mail or fax it.

To download, click the appropriate link for yourself to open the form, then right-click on the form and select “Save As”.

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ADULT REFERRAL & ASSESSMENT PACKAGE

COLLEAGUE APPLICATION PACKAGE

 

ADDENDUMS:

THESE MUST BE FILLED OUT TO ATTEND THIS CLINIC

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CONSENT FOR TREATMENT

CONSENT FOR RELEASE OF INFORMATION

HOUSE RULES

METHADONE/SUBOXONE CONTRACT

SAFE/UNSAFE MEDICATION

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YOUTH REFERRAL PACKAGE

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All assessment and referral packages are filled out with the client and returned to Wilp Si’Satxw Community Healing Centre. The complete application, including pre-admission medical exam and T.B. test (only if T.B. test is positive then a chest x-ray is required), must be submitted before booking a treatment date. Please be advised clients will be booked as we receive their Complete referral package and medical examinations by mail or by fax.

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• Applications are accepted by referral from any of the following sources:

• Alcohol & Drug Counselors

• Band Social Workers

• NNADAP Workers

• All Referral Workers

• CHRs

• Any Treatment or Recovery Centre

 

Please click here for guidance on writing the referral letter.