New Customer Registration Form

  • Last Door Recovery Society – 90‑day Inpatient Treatment Application

  • Program Length: 90 days (inpatient / bed‑based)

    This application is for individuals seeking admission to a 90‑day inpatient addiction treatment program at Last Door Recovery Society in New Westminster, BC. Please answer the following questions as honestly and completely as you feel comfortable. Special thanks to the Kendall Gender Foundation for supporting this cause

  • Eligibility Confirmation

  • Are you 19 years of age or older?*
  • Do you Identify as a male?*
  • This funded treatment space is intended for anyone who identifies as male and is part of the LGBTQIA2S+ community. Does this apply to you? (This question is asked respectfully to ensure this funded space is offered as intended.)*

  • Contact Information

  • Addiction/Health History

  • Have you experienced any mental health challenges (for example: anxiety, depression, trauma, psychosis, or other concerns)?*
  • Have you attended addiction treatment before?*

  • Motivation for Treatment

  • Program Information & Acknowledgement

  • Please read carefully: -Last Door is a nicotine‑free program. Support will be provided to help participants overcome their nicotine use. -Treatment focuses on drug, alcohol, and gaming addictions. -Not all applicants will be accepted. -Individuals who are shortlisted will be contacted for a screening call by the Last Door Recovery intake team. -Travel to New Westminster is not provided. -Prescribed medication costs are the responsibility of the client. Do you understand these statements?
  • Last Door is a social model program, where recovery happens through peer support, written assignments, self reflection written assignments and medical guidance from an addictions physician. I am aware that I will be attending mutual support groups that include 12 step meetings. Clients participate in daily group therapy, family members are invited to participate in Last Door's family program, as well as a weekly partners group for clients partners. I have reviewed www.lastdoor.org to see what the program is and feel that is suitable for my recovery journey.
  • Consent: I agree to have someone from Last Door Recovery Society contact me by phone at the number I have provided.

  • Confidentiality Statement

    All information provided in this application is protected and kept strictly confidential. Information will not be shared with anyone outside of Last Door Recovery Society, including the Kendall Gender Foundation. Applications will be reviewed only by the Last Door Recovery Society intake team.
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