Pre-Admission Screening Checklist

Pre-Admission Screening Checklist
Disclaimer: The information you provide will be reviewed by our team, and your application will be considered regardless of your responses. Please answer honestly and openly, as this will help us ensure the best support for your recovery.
Clinical Criteria
Mental Health Support: Are you currently experiencing active psychosis, severe unmanaged mental health symptoms, or any condition that requires more intensive psychiatric care than this program provides?.

YesNo
If you have any mental health conditions or diagnoses, please describe them here:
Substance Use:

I have not used alcohol or other substances in the past 7 days and do not require detoxification or medical intervention at this time.
Medication Compliance:

I am willing and able to follow all prescribed medications and clinical recommendations that are necessary for my recovery.
Please list any medications you are currently taking:
Controlled Substances:

I am not currently using amphetamines, benzodiazepines, opiate pain killers or other narcotics.

Clinical Criteria