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Intake Forms

Help us find the right place for you.

Getting to know you, your family and community of support, and your current treatment team ensures that we can correctly identify the appropriate level of care and create an individualized treatment plan to begin your recovery journey.

Submit Intake Forms

Your forms will be carefully reviewed by a master level clinician on our Intake Team, and you will be contacted within one business day of submission.

Submitting Intake forms simply allows us to learn about you and your treatment needs, it does not in any way commit you to treatment.

Please fill out forms accurately and in their entirety.

We really appreciate your time completing these forms so that we can find the best level of care and fit of facility for you or your loved one.

Child & Adolescent Preliminary Assessment

Adolescent Program Evaluation

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Adult Preliminary Assessment

Adult Program Evaluation

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Release of Information

Please submit one form for each healthcare provider. If you are 18 years or older and would like a parent or family member involved in treatment, please submit a release form for that person.

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Insurance Information

Let us research your healthcare benefits on your behalf

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Healthcare Provider History

A comprehensive history of recent medical and center treatment

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Custody / Guardianship Documentation

Regarding a ruling for custody or guardianship of an incoming patient

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Health Information Management

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Every Journey Begins With a Single Step

Contact & Locations