Client Application Form

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Addiction Treatment Admissions
Client Application Form

All of our of programs are working closely with the Health Department and CDC guidelines to ensure we continue to provide safe and effective treatment for our clients. We remain open and are accepting admissions.

Step 1 of 8

Client Information

Parent/Guardian/Sponsor Information

Placement Information

Placement/ Intervention History

Psychological History

Medical Information

Insurance Information

REDEFINING THE CLINICAL EXPERIENCE

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