Application for Admission

For a printable application, click here. If admitted, you will still need to fill out the application online before or upon arrival to the program.

IMPORTANT – PLEASE READ BEFORE YOU APPLY:

Our program is a 12-month commitment with three phases.

✅ The program is very structured, disciplined, and intensive. You must say “yes sir” and “no sir,” ask permission to go to the restroom, and follow strict rules designed to help you become a respectful, responsible man who can thrive in life.

✅ This is a faith-based, spiritual environment. You will be learning about Jesus daily through prayer, worship, Bible study, and classes.

✅ Our program focuses on small group therapy and evidence based therapy including inner healing—working through trauma, past pain, and the root reasons you turned to addiction. We are committed to helping you heal from the inside out, not just stop using substances.

✅ No relationships with girlfriends or romantic partners are allowed. You may only communicate with a spouse you are legally married to.

✅ No contact with your family for the first 30 days. After 30 days, you may have one phone call per week, one visit per week, and you can write letters right away.

✅ No smoking, vaping, or dipping. No nicotine is allowed.

✅ Phones:
You will not be allowed to have a personal phone during the first 6 months of the program. In Phase 3 (Final 6 Months), you will be issued a phone by the program that you can use responsibly while learning to handle your freedom.

RESIDENT RIGHTS & CONFIDENTIALITY 

Residents in this facility have the following rights: 

1. Clients have the right to voice grievances to staff of the facility, to the licensee, and to outside representatives of their choice with freedom from restraint, interference, coercion, discrimination or reprisal. 

2. To be treated with consideration, respect and full recognition of their dignity and individuality; 

3. To be protected by the licensee from neglect; from physical, verbal and emotional abuse (including corporal punishment); and from all forms of misappropriation and/or exploitation; 

4. To be assisted by the facility in the exercise of their civil rights; 

5. To be free of any requirement by the facility that they perform services which are ordinarily performed by facility staff; 

6. To be allowed to send personal mail unopened and to receive mail and packages which may be opened in the presence of staff when there is reason to believe that the contents thereof may be harmful to the client or others; 7. To privacy while receiving services; 

8. To have their personal information kept confidential in accordance with state and federal confidentiality laws; 

9. To ask the facility to correct information in their records. If the facility refuses, the client may include a written statement in the records of the reasons they disagree; 

10. To be informed about their care in a language they understand; 

11. To vote, make contracts, buy or sell real estate or personal property, or sign documents, unless the law or a court removes these rights; 

12. To participate in the development of the client's individual program or treatment plans and to receive sufficient information about proposed and alternative interventions and program goals to enable them to participate effectively; 

13. To participate fully, or to refuse to participate, in community activities including cultural, educational, religious, community services, vocational and recreational activities; 

14. To have free use of common areas in the facility with due regard for privacy, personal possessions, and the rights of others; 

15. To be accorded privacy and freedom for the use of bathrooms when needed; 

16. To retain and use personal clothing and appropriate possessions including books, pictures, games, toys, radios, arts and crafts materials, religious articles, toiletries, jewelry and letters; 

17. If married clients reside in the facility, privacy for visits by spouses must be ensured, and if both spouses are clients residing in the facility, they must be permitted to share a room; 

18. Clients have the right to associate and communicate privately with persons of their choice including receiving visitors at reasonable hours; and, 

19. Persons supported have the right to be given privacy and freedom in the use of their bedroom/sleeping area. 

20. To be informed of a proposed limitation or modification of their rights or the rules of the facility; 

21. To not have responsibilities for the care or supervision of other residents. 

CONFIDENTIALITY 

The operator will ensure that client records and any other information regarding the clients will remain confidential. Access to records may be allowed only by a release of information form signed by the client. The release form must be complete with the date of signature, the specific information to be released, and the recipient of the information. 

1. To not be required to make public statements which acknowledge gratitude to the operator for services provided; 2. To not be required to perform in public gatherings; 

3. To not have identifiable photographs taken of them and/or used without a signed written consent; 

4. To not have responsibilities which would require them to have access to confidential information; 

5. The facility staff will comply with applicable confidentiality laws and regulations. 

If residents have a complaint, they are encouraged to discuss the problem with the operator promptly. The operator will attempt to resolve the problem and will document the discussion in the client record. If the client is not satisfied with the resolution, he or she may contact any of the below for assistance. 

Any question or specific concerns regarding residents' rights or to report a complaint may be directed to any of the following: 

Facility/Operator: Recovery Soldiers Ministries

Telephone: 423-518-1450

Disability Rights TN 

Telephone: 1-800-342-1660 

Long Term Care Ombudsman Telephone: 1-877-236-0013 

Department of MHSAS Office of Licensure Telephone: 1-866-797-9470 

Department of Human Services-Adult Protective Services Telephone: 1-888-277-8366 (1-888-APS-TENN) 

HIPAA Information and Patient Privacy Consent

Our Notice of Privacy Practices provides information about how we (“the Practice”) may use and disclose protected health information about you (aka “Patient”). The Notice contains a Patient Rights section describing your rights under the law. You have the right to review our Notice before signing this Consent. The terms of our Notice may change, and if so, you may obtain a revised copy by contacting our office. 

You have the right to request that we restrict how protected health information about you is used or disclosed for treatment, payment or health care operations. We are not required to agree to this restriction, but if we do, we shall honor that agreement. 

By signing this form, you consent to our use and disclosure of protected health information about you for treatment, payment and health care operations. You have the right to revoke this Consent, in writing, signed by you. However, such a revocation shall not affect any disclosures we have already made in reliance on your prior Consent. Recovery Soldiers Ministries provides this form to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). 

The patient understands that: 

• Protected health information may be disclosed or used for treatment, payment or health care operations. 
• All other disclosures by Recovery Soldiers Ministries will require specific authorization by you unless required by law. 
• Recovery Soldiers Ministries has a Notice of Privacy Practices and that the patient can review this Notice and receive a copy. 
• Recovery Soldiers Ministries reserves the right to change the Notice of Privacy Policies. The new policy will be available upon request from our office. 
• You have the right to restrict the uses of their information used for treatment, payment or operations, but the Practice does not have to agree to those restrictions.

I furthermore give Recovery Soldiers Ministries authorization to disclose information about my program progress to my immediate family. This statement of consent is subject to revocation by the patient at any time, except to the extent that the ministry of person who is to make the disclosure has already acted in reliance on it.

Receipt and Acknowledgement of Privacy Practice Notices

 

Our Notice of Privacy Practices (NPP) is available by clicking here: NPP

 

I hereby acknowledge that I have received and have been given an opportunity to read a copy of the Recovery Soldiers Ministries Notice of Privacy Practices. I understand that if I have any questions regarding the Notice or my Privacy Rights, I can contact Recovery Soldiers Ministries.

Social Media Consent Form

 

Recovery Soldiers Ministries is pleased to participate in social media outlets such as Facebook, Instagram, YouTube, Google+, etc. Through these venues, we share pictures, updates, testimonies, and other inspiring and helpful information that may benefit our donors, partners, and families of those in the program. With the expressed permission of our program participants, we are pleased to share posts congratulating students on accomplishing their goals and completing the program.

I give my consent to allow Recovery Soldiers Ministries to post updates, videos, or photographs of me on social media.

Facility Monitoring and Security

I understand that RSM utilizes AV monitoring systems for the purposes of client, staff, and property safety and security. I acknowledge that I may be recorded while on the premises. I understand that these recordings may be reviewed by authorized personnel, including but not limited to, facility staff, management, and legal authorities as required by law or internal policy. I understand that these recordings will be stored securely and accessed only for legitimate purposes related to safety, security, incident investigation, quality assurance, and compliance. By participating in the program, I consent to this AV monitoring.

Affirmation

By signing my name below, I hereby state that I have answered all the questions on this form with complete truth and to the best of my ability. The name I have provided is my name and I have completed this form either independently or voluntarily through a second party.