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 email@example.com 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 firstname.lastname@example.org.
Coronavirus (COVID-19) Screener – Required for all evaluations, and all admissions until further notice.
The below two forms are required for all residential admissions
*Download 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)
*Supports for medical needs (Online form submission)