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The Extended Care Partners of The Watershed
"The road to recovery is often 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 Type:
 		 (Required- please click 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 click 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 click all that apply)

Children Adolescent Family
Couples Individual Group
EMDR Experiential Interventions
Psychodrama Other (Please Describe)  
Description of other:

    Types of Service: (Required - please click 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 click 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:
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 ex8384 (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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