ADSTV - Referral Form For Addictions Supportive
Housing Program (ASH)

Referral Form Instructions:  ASH Referral Process

The purpose of this form is to provide initial entry for clients into the ASH program. This form may be completed by a service agency, current counselor or the applicant.

1. Complete the ASH referral form, and fax it to 519-673-1022.
2. If you live in London or would like to access services in London, then you can simply attend Walk-In Intake at our London office. If you live in Strathroy, and/or Oxford and Elgin County, please indicate this on the referral form and we will direct the information to the right counsellor.
3. Walk-In Intake can be accessed at the London Office (200 Queens Avenue, at the intersection of Queens and Clarence) from 1:15 to 3:15 p.m., on Monday and Thursday. Please be aware that the office is closed on all statutory holidays.
4. Please call (519-673-3242 ext. 222) to confirm that Walk-In Intake is available on the day that you plan to attend.

Please call the office for more information or email us at intake@adstv.on.ca

Section 2: Referral Flow Chart

referral_flow_chart.pdf       referral_flow_chart.doc

Section 3: Download "Referral Form"

  ash_referral_form-2011.pdf       ash_referral_form-2011.doc

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