Schedule an Appointment

Please use this form to schedule your first BASICS or Screening and Brief Intervention appointment.

AODE Program staff will schedule your session using the schedule that you provide. You are responsible for having an appointment scheduled prior to your deadline. If you do not attend a scheduled appointment, you may be fined for failure to comply.

First Name	Last Name


Class Year	Fordham ID Number
	- -

Type of Referral


Cell Phone Number	Preferred Email Address (one that you check regularly)


Who Referred You (i.e. name of the Residential Life/Student Affairs administrator)


Weekly Class Schedule


Schedule of Other Obligations for the Next 2 Weeks (i.e. work hours, practice, internship)

All appointments occur during regular business hours (Monday-Friday 9am-5pm).

For a description of BASICS and the Screening and Brief Intervention program, a list of Frequently Asked Questions, staff member bios, and information regarding other services provided by AODE, please visit our website: www.fordham.edu/aode or contact us directly at AODEProgram@fordham.edu.