Patient Enrollment

Our associates are highly qualified and experienced, and are passionate about the care they provide. Not only will our providers treat your existing conditions, we will also help to create a custom recovery plan that's right for you. We strive to help you improve your quality of life.

 

Please begin with the Capeside Addiction Care Patient Enrollment Form. Click submit when finished. A Patient Representative will contact you to complete the enrollment process.

All forms are made and processed through 123 Form Builder. Your information is secure, and will only be used for the purpose of building your patient file with Capeside. View 123 Form Builder’s Privacy Policy here.

1.

Enrollment

2.

Text Consent

3.

HIPAA Authorization

4.

Authorization to Release Healthcare Information

5.

Program Responsibilities

6.

Treatment Contract

7.

Relapse Prevention Plan

8.

Medical History

9.

Health Questionnaire

10.

Mood Questionnaire

11.

Anxiety Questionnaire

12.

Drug Abuse Screening

13.

Probation Agreement

Virtual Addiction Groups

 

Monday: 7-8pm

Tuesday: 8:30-9:30am | 5-6pm

Wednesday: 10-11am | 5-6pm | 7-8pm

Thursday: 8:30-9:30am | 5-6pm | 7-8pm

Friday: 9-10am | 12-1pm | 3-4pm

 

Dial-in: 1-512-489-3100 Ext. 4820351

For Life-Threatening Emergencies Call 911

Phone: 910-791-6767

Fax: 910-399-2190

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© 2017 by Capeside Addiction Care