The treatment coordination segment of my practice was developed in response to listening to story after story after story about the struggle and frustration family members and recovering individuals have had in finding the treatment center or program that was a fit for both the addicted person and their family. There are thousands of programs across the country that claim to have “the right program for treating addictions.” Unfortunately, it’s next to impossible to find what the “right fit of treatment” is for any client without first considering their presenting problem, client and family therapy history, client and family special needs, psychiatric history, personal preferences, resources for treatment, etc. Furthermore, a program that works exceptionally well for one client with a particular set of circumstances may not be appropriate for another client who has his or her own unique set of problems, circumstances, and concerns.

Treatment is often a major investment of time, emotion, and finances for clients and their families. As such, information that might indicate a “good fit” in treatment should be clinically reviewed and considered prior to contacting a treatment center. I employ my 11 years of experience and contacts within the national addiction treatment field to help place each client, based on their own unique circumstances and presenting problems, with a choice of programs that will give them the best chance of hope and recovery. The service can also be used by families to establish contact with an interventionist or co-dependence treatment provider.

The cost of Treatment Services is a one-time fee of $250.00 payable by credit card prior to services being rendered. Services included in this fee are: in-depth review of clinical information provided on-line and thru a 30 min phone interview with the client and/or family, a list of 2 to 3 treatment providers that meet criteria identified in the assessment, initial contact, with the treatment providers, verification and/or explanation of insurance benefits, and follow-up post admission and post-discharge phone calls. Click here to get started or call (225) 769-7575.

Confidentiality Statement: Information about you or your care will not be released to anyone, including spouses or parents (clients 17 years or older) without your express written consent or subpoena from a Judge. As mandated by law and for your safety, confidentiality will be breached in high risk situations of child/elder abuse or neglect and in case of homicidal or suicidal threats and behavior.

All information is sent to a secure and private email address and viewed only by Rudy L Troyer, LCSW, LAC and Associates. Information will be released to a treatment provider on request of the client only with written consent per federal confidentialty laws.

About You and Client
Your First Name:	Last Initial:	Relationship to client:
Client First Name:	Last Initial:	Age: Date of Birth: Sex:
State of Residence:	Ethnicity:	Marital Status:
Children (List sex and ages): Current Living Arrangement:
Level of Social Support: Select One Low Medium High Is client willing to enter a treatment program at this time? Select One Yes No Reason client or family is seeking treatment at this time?
Is the client required or mandated to enter and complete a treatment program? Select One Yes No
Has the client been in treatment before? Select One Yes No	What kind of Treatment? Select One Therapy Counseling Psychiatry In-Patient Intensive Inpatient DAT Program Residential Other
Provider/Program	Dates of Service	Type of Service
Outcome Select One Ongoing Completed Discharge Non-Compliance Discharge Against Medical Advice	What are the current substances the client is using?	How Long?
How Often?	Amount Used?	Last Use?
If Addiciton other than or in addition to substance abuse (e.g. sex, gambling, internet, food/eating), please describe here:
Does the client have a history of seizures? Select Yes No Does the client have a history of having substance abuse withdrawal or going to hospitals for detox? Select Yes No
What medication is the client currently taking?
Is the client presently under physician care? Select Yes No
Does the client have any diagnosed psychiatric, behavioral, or medical conditions? If yes, please list.
Does the client have any medical disability? Select Yes No
Has the client ever been diagnosed with a learning disability or have difficult reading and writing? Select Yes No
Has the client ever attempted suicide, self mutilation, etc? Please describe (If the client is presently suicidal, please stop this assessment and call 911 immediately)
List pending and previous legal charges and arrests.
Is the client currently on probation or parole? Can he or she leave their state of residence? Select Yes No
Is the client currently employed? How Long? Please describe type of work?
Highest education completed
Is the client currently in school? Select One College High School Graduate School Not in School
List any issues that the client or family feels must be addressed for treatment to work
Will the client need psychiatric follow-up or medication management during treatment? Select Yes No
Any preferences for location of treatment? Select One No Preference Home State Northeast East Coast South East Central US Gulf Coast Mid West West
Describe the client's interests:
Describe any dislikes:
Requests for treatment: Select One 12-Step Based Altervative Long Term Half-Way House 30 Day Onsite Detox Dual Diagnosis Rural Setting Urban Setting Co-ed Gender Specific Affordable Exclusive Professional Program Age Specific Family Therapy
Other:
Does the client have health insurance? Select Yes No
Will the client or family be able to self-pay for treatment? Select Yes No
Are finances a barrier to treatment? Select Extremely Somewhat Not At All
Is the Family willing to participate in treatment and their own counseling? Select Yes No

NOTE: After the form is submitted you will be redirected to an online payment page.