Online Forms
Please click on the “Online Fillable Form” that you wish to complete. This will allow you to securely fill out, sign, and submit the form through our website to the location that you are enrolling/enrolled at. You can also upload important documents to us through this process. A copy of the completed form will be emailed to you at the email address you provide.
- Enrollment Package With Virtual Health Form
- 12 HRS Assessment Form
- Authorization For Face-to-Face Telephone Session
- Authorization For Release Of Confidential Records
- Client Email/Texting Informed Consent Form
- Client Exit Evaluation
- Client Information Update Sheet
- Driving Under The Influence (DUI) Program Enrollment Participant Information/Informed Consent and Agreement
- Exit Interview
- INTAKE: Self Alcohol/Drug Assessment
- Personal Data Intake Information Form
- PrePost Test Fillable
- Virtual Services Agreement
- TEXT/SMS Communication Consent Form
- Transition Sessions
- Payment Form
- Reinstatement Transfer-In
- Virtual Services Attendance Verification Form
Downloadable Forms
Enrollment Packets
All Forms for Enrollment Included in one PDF document. You have the option to fill the form out electronically and email it directly to us OR you can print it out, hand write the information in and bring it with you to your enrollment appointment.
Individual Enrollment Forms
Below are individual forms that included in the Enrollment Packets above. You have the option to fill the form out electronically and email it directly to us OR you can print it out, hand write the information in and bring it with you to your enrollment appointment.
Intake Self-Assessment Form (English)
Intake Self-Assessment Form (Español)
12 HR Assessment Form (English)
12 HR Assessment Form (Español)
Miscellaneous Forms
Client Info Update Form (English)
Client Info Update Form (Español)
Acuerdo de Servicios Virtuales
To download & save form on your computer: Right Click on Form -> Click “Save Link/Target as” -> Choose Folder/Desktop -> Click Save