Drug Addiction Treatment Center the watershed addiction treatment programs The Watershed Addiction Treatment programs offering drug addiction treatment as well as alcohol addiction treatment. America's premier drug addiction treatment center 24 hour addiction treatment helpline at the watershed addiction treatment programs for drug addiction

The Extended Care Partners of The Watershed

Road to Recovery is a two way street

Sometimes it begins with you the professional looking for the best in-patient solution for those in need. While at other times it begins here at The Watershed when one of our helpline resource coordinators or discharge planners is searching for an addiction professional referral in your local community.

At The Watershed we are committed to providing all of our patients the best possible opportunity to achieve and maintain long-term recovery from the disease of addiction.

We offer a higher standard of care at The Watershed which is why every patient we treat is guaranteed a professional referral in their local area before they are discharged. We successfully treat them and help them find their way before handing them off to you to continue their journey on the road to recovery.

The Watershed Extended Care Partner Application

To apply to become a certified Watershed Extended Care Partner, please complete and submit this form in its entirety.*

Resource

Required - Please check all that apply
 

Physician

Therapist

Interventionist

Continuing Care Facility

First Name:

Middle Initial:

Last Name & Credentials:

Organization:


If organization is provided, you will be listed by your organization name.

Years In Practice:

Years

Qualifications:

Description of Services:

Address:

City:

State:

Zip:

Phone:

Phone 2:

Fax:

E-mail:

Website:

Specialty Areas

Required - Please check all that apply
 

Axis II Disorders

CD/Alcohol

Comp Gambling

Eating Disorders

Internet Addiction

Mood Disorders

Sexual Addiction

Trauma

Other (Please Describe)

Description of Other:

Modalities

Required - Please check all that apply
 

Children

Couples

Adolescent

Family

Individual

Group

EMDR

Interventions

Experiential

Psychodrama

Other Please Describe

Description of Other:

Types of Service

Required - Please check all that apply
 

Acute Care

Extended Care

Halfway House

Inpatient/Hospital

IOP

Outpatient

Partial Hosp/Day Program

Residential

Other (Please Describe)

Description of Other:

Fee Range:

 

Length of Stay:

 

Accepted forms of payment

Required - Please check all that apply
 

Medicare

Insurance

Private Pay

Self Pay

Please describe your philosophy in 50 words or less:

Professional References

Required - Please list three

Name:

Phone Number:

Name:

Phone Number:

Name:

Phone Number:

Security Code


By submitting this form online, I hereby authorize The Watershed to include the above information on their database and to publish such information on The Watershed's website, print and other electronic media. I also agree to receive information or contact by The Watershed Treatment Programs Inc. and agree to participate in The Watershed Alumni program.

The Watershed Treatment Programs, Inc
200 Congress Park Dr. Suite 101
Delray Beach, FL  33445

1-877-416-9566 Ext: 8384 (Referrals)

*Note: Please be advised that The Watershed will evaluate all submissions and will retain the right to add or subtract listings from the The Watershed website at their discretion. Submission of this form does not guarantee inclusion on The Watershed's website. The Watershed cannot be held liable for the accuracy of information submitted or displayed. Applicant agrees to release and hold harmless The Watershed and all of its subsidiaries, owners, officers, directors, employees, and agents from any and all liability relating to the use of any information contained herein.

 

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