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.

 

To enroll, please complete each of these forms to the best of your ability.

A patient representative will contact you to complete the process.

1.

Enrollment

2.

Text Consent

3.

Authorizations

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