Skip to main content

Take the First Step Toward a Brighter Future

Completing this assessment is quick and easy. Simply follow the step-by-step prompts, answering each question honestly based on your current situation. Your responses will help our admissions team understand your needs and determine the best treatment options for you. Once submitted, a team member will review your assessment and reach out to discuss your next steps. Get started now and take the first step toward recovery!

Please enable JavaScript in your browser to complete this form. – Step 1 of 23

What is your First and Last Name? *



Are you looking for treatment for yourself or a loved one? *

What is your loved ones name? *

Have you been to treatment in the past?

Has your loved one been to treatment in the past?

Do you have health insurance?

Does your loved one have health insurance?

Who is your insurance through?

Who is your loved ones insurance through?

Is private pay an option?

Example: Blue Cross Blue Shield, Aetna, UHC etc.You can find this on your insurance cardWhich substance(s) are being used

Are you or your loved one experiencing withdrawal symptoms?

Has there been use within the last 7 days?

Have your or your loved one experienced Suicidal or Homicidal Ideation? *

Are you or a loved one currently experiencing, or have a recent history of, any of the following?

Do you or your loved one have any major medical issues that may impact ability to perform activities of daily living?

Completion of self care tasks such as eating, walking, hygiene, dressing etc.

I am interested in the following services *


Loading