Admissions Process for Second Chances Addiction Recovery Center

Taking care of our guests is a top priority at Second Chances. This quality of care begins during the admissions process into any of our rehab programs. We want to assure you that your communication with us is always private and confidential. We will not share your information with anyone.

Upon first contact, an individually assigned intake coordinator will work with the guest or their main point of contact to obtain:

Demographic information
Insurance or Medicaid information
The guest’s substance abuse history
Any additional, pertinent treatment history

Then, the intake coordinator will check benefits and make sure that the guest meets medical criteria. Second Chances works with several major insurance companies as well as Medicaid. Our team can also sign guests up, on-site, for Medicaid coverage if needed. Please visit our Insurance and Medicaid page for more details

Once insurance or medicaid funding checks out and it is determined that the necessary medical criteria is met, the guest is assigned to a counselor and scheduled to come in for their treatment program.

From there, the counselor will work with the quest and their family to assign and communicate further details about their personalized treatment plan.

This intake and admissions process can take anywhere from 24-48 hours depending on the variables of each guest’s case and needs.

View Items to Bring

Intake Assessment

Please fill out the form below and click submit to begin the process. We are only determining if Second Chances could be a good fit for you or your loved one’s current treatment needs. We are not here to judge your situation. We know that reaching out for help is a courageous step.

Once you have completed the online intake form and submitted it, we will review the information and contact you or click the button below to download an intake form to fill out.

Download the Intake Form

Date *

Client Name *

First

Last

Mailing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Client Date of Birth *

Client Gender *

Client Email

Client Cell Phone Number

Client Home Phone Number

Client Occupation

Can We Leave a Message?

Home
Cell

Please tick all that apply

Substances the Client is Currently Misusing *

Has the Client Been in a Substance Abuse Treatment Program Before? *

What Treatment Type is the Client Seeking? *

Will the Client be Using Insurance? *

Does the Client Have Any Current Legal Issues? *

Does the Client Have Any Major Health Issues? *

Referer's Contact Information

Referrer's Name *

First

Last

Referrer's Contact Number *

Referrer's Email *

Relationship to Patient

Admissions Process

Admissions Process for Second Chances Addiction Recovery Center

Intake Assessment

Referer's Contact Information

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