1)NAME OF THE ORGANIZATION:

2)EXECUTIVE DIRECTOR'S NAME AND CONTACT INFORMATION:

3)EMAIL, PHONE, AND FAX NUMBER OF THE ORGANIZATION:

4)LOCATION OF SERVICE INCLUDING ADDRESS, AND POSTAL CODES (THERE MAY BE MORE THAN ONE TREATMENT LOCATION UNDER THE SAME ORGANIZATION)

5)LIST OF SERVICES PROVIDED IN THE ORGANIZATION:

LIST WHAT SERVICES ARE PROVIDED FOR PEOPLE IDENTIFIED SPECIFICALLY WITH CONCURRENT 6) DISORDERS (INDIVIDUAL, FAMILY, GROUP):

7)LIST THE VARIOUS PROFESSIONS AND PROFESSIONAL SERVICES AVAILABLE WITHIN THIS TREATMENT MODEL (E.G., PSYCHIATRIST, NURSE, MENTAL HEALTH COUNSELLORS):

INDICATE IF THESE SERVICES ARE BASED ON SEQUENTIAL, PARALLEL, OR INTEGRATED MODELS OF SERVICE DELIVERY:

8)LANGUAGES OF SERVICES AVAILABLE TO CLIENTS

9)LIST THE ADMISSION CRITERIA AND CURRENT TIME FRAMES WITH RESPECT TO THE WAITING LIST.

10)PROVIDE A SUMMARY OF THE SCREENING AND REFERRAL PROCESS INCLUDING WHO CAN MAKE REFERRALS:

11)FUNDING SOURCES:

GIVE ANSWERS TO THE QUESTIONS ABOVE BY CONSIDERING THE MONARCH RECOVERY HOME SUDBURY, ONTARIO CANADA.