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Collier County Treatment Courts Referral Form
* Required
Email Address
Treatment Court Sought
Drug Court
Mental Health Court
Veterans Court
Referral Source Information
Referral Source Name
Referral Source Phone Number
Referral Source Agency
Judge
State Attorney's Office
Public Defender's Office
Office of Criminal Conflict and Civil Regional Counsel
Private Defense Attorney
Community Treatment Provider
Probation
Private Citizen or Family Member
Self-Referral
Other:
Defendant Information
Defendant's Name
Defendant's Date of Birth
Month Year
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Fr
Sa
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Cancel
OK
Defendant's Home Address
Defendant's Phone Number
Is the Defendant In Custody?
Yes
No
I'm Not Sure
Collier Case Numbers
Please ensure you have entered valid case numbers to avoid delays in processing
Pending Out of County Cases
Please ensure you have entered valid case numbers to avoid delays in processing
Defense Attorney
Attorney Phone
Does the defendant require an interpreter?
Yes (Language):
No
Has the defendant participated in a Treatment Court before?
Yes
No
I'm Not Sure
Referral Information
Reason for referral (be specific)
Date & Location of previous Baker Acts
Date & Location of Previous Hospitalizations/Residential Treatment
Other Treatment History (if any)
Transcripts
