Dear Client:  We are glad you are here to visit us. You can use the links below to fill out forms before to be admitted to a program before you see us in the office. Remember, you must have an evaluation to know what level of care is recommended to help you best. If you haven’t had an evaluation yet, please click on this link to start the evaluation forms.

Once you submit your forms, please let us know that you did by emailing us at information@addsiowa.org and/or calling us at any of these locations listed on our homepage.

If you have any questions, don’t hesitate to call in for assistance or email us at information@addsiowa.org.


Pre-Admission Forms

Application for Services / Financial Form (Pre-Admit)


– Informed Consent for Electronic Communication (Pre-Admit)

Admission Forms

Outpatient

Application for Services / Financial Determination (Unscheduled Form)


HIV / STI Testing for Orientation Form


Informed Consent for Electronic Communication – Unscheduled version


Orientation Information (EOP)


Orientation Information (IOP)


OWI Class – OWI 321-J: Consent to Release of Alcohol and Drug Abuse Information

ROI Iowa Consortium


ROI Iowa WORKS Burlington, Iowa from ADDS to Iowa WORKS


ROI Iowa WORKS Burlington, Iowa from Iowa WORKS to ADDS


Tuberculosis Report


Residential (* means required pre-admission)

*Coronavirus (COVID-19) Residential Screener Must Be Completed

*Fill out the tobacco / nicotine and 60 Day acknowledgement here (Online form submission)

*Download tobacco / nicotine and 60 Day acknowledgement here (Paper form download)

*Supports for medical needs (Paper form download)

*Fill out Supports for medical needs (Online form submission)


Consent: Activities Outside the Treatment Center

Application for Services / Financial Determination (Unscheduled Form)


Great River Medical Center Emergency Dept. Release – Treating Professional


Hillcrest Family Services Release – Treating Professional


Hillcrest Family Services Release of Information – Administrative Staff Member

HIV / STI Testing for Orientation Form


Medication Risk Disclosure


Orientation Information (Residential)


ROI Iowa Consortium


ROI Iowa WORKS Burlington, Iowa from ADDS to Iowa WORKS


ROI Iowa WORKS Burlington, Iowa from Iowa WORKS to ADDS

Release of Information – Community Health Center Administrative Staff Member


Release of Information – Community Health Center Treating Professional for Physical


Release of Information – Heritage Park Pharmacy


Release of Information – Hy-Vee Pharmacy


Residential TB Form