Hoarding Referral Form

Form Template

Clutter and hoarding can impact the health and well-being of an individual and their family.

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People who hoard may not be able to recognize the problem and may require intervention. This Hoarding Referral Form Mobile App provides an opportunity for an individual or agencies to recommend a hoarder for support services. The app user can record basic client information along with any known mental disorder, health issues and the health professional in the care of the person.

The user can record details about the home including other people living in the home if there is an animal present, any incidents of insects or rodents, and any other unsanitary living conditions. This form includes sections to explain the recommendation for support services and any additional information that may be important to understanding the hoarding behavior. This hoarding referral app would be an excellent way for agencies or individuals to recommend a hoarder for treatment when there are health and safety or environmental health risks involved.

Easily accessible on a smartphone, tablet or PC, you can fill out the referral form digitally and directly pass on to clinical treatment programs, cognitive behavior therapy centers or other treatment resources for adults, in real time. Quick action can help to reduce stress on behalf of the patient and help them to get the intervention and treatment they need.

Features
  • GPS
  • Image Capture
  • Conditional Fields
  • Submission Editing
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Platforms
  • iPhone
  • iPad
  • Android
  • Windows
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Integrations
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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*The Capterra SoftwareAdvice ​and GetApp logos are a service mark of Gartner, Inc. and/or its affiliates and is used herein with permission.*

Don't take our word for it...

“I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.”

Dave Kramer, PennLine Service

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