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Reentry Halfway House Referral Form
Calling All Men to the Development Of Character (CAMDOC)
1300 NE 8th Street, OKC, OK 73117
admin@camdoc.org 
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Your Full Name, Agency, and Title *
Phone Number: *
Email: *
Client's Full Name: *
Date of Admit: *
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Estimated Discharge Date: *
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Please explain the individual’s need for a sober living environment at this time (overall assessment of current state and recent progress). *
Please provide below all necessary information for the individual being referred. Any information not provided will be assumed as non-applicable to the individual.

List all information regarding:
-Substance Abuse Diagnosis(es)
-Mental Health Diagnosis(es)
-Upcoming Court Dates (Give Dates)
 *
Describe how the applicant responds to program rules, suggestions, or authority. *
Client’s current insurance provider: (type NA if the client does not have insurance) *
Does this client have full benefits? *
Has a medical exemption been completed for this client if needed? *
If so, date completed?
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Recommendations - Additional comments or information you would like to provide. *
By typing your full name, title, and agency below, you are verifying that all the information you have provided is true and accurate to the best of your knowledge. *
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