form for collection on telephone inquiries for substance abuse tr

[Legal]

I am trying to deveop a form that will assist in collecting information about
the referral's substance abuse treatment needs in order to testify before the
city officials on the needs of establishing more treatment beds for our
residents.

Information to be collected such as date, name (first only), jurisdiction,
drug(s) of choice. sex, age, number of children, other concerns to be met;
living situation

 

[Robert M. Franz (RMF)]

Hi Legal

I am trying to deveop a form that will assist in collecting information about

[..]

Take a look here:

I'm designing a form that needs to have “fill-in-the-blanks†lines. What
is the best way to create them? (by Suzanne S. Barnhill and Dave Rado)
http://www.mvps.org/word/FAQs/TblsFldsFms/LinesInForms.htm

Greetings
Robert