Comprehensive Client Assessment

Please complete the following assessment form to help us better understand your needs. This information allows our team to tailor a personalized treatment plan that provides the most effective support on your path to recovery. All responses are confidential and used solely for clinical purposes.

Please fill out the form for your FREE assesment

WHERE DID YOU HEAR ABOUT OUR PROGRAM?

PARENT'S FIRST NAME

PARENT'S LAST NAME

PHONE NUMBER

EMAIL ADDRESS

TEEN'S FULL NAME

TEEN'S BIRTH DATE

SUBSCRIBER OF INSURANCE

INSURANCE ID #

INSURANCE NAME

IS YOUR TEEN STRUGGLING WITH ANXIETY?

IS YOUR TEEN STRUGGLING WITH DEPRESSION?

ARE YOU CONCERNED ABOUT SUBSTANCE USE?

HAS YOUR TEEN BEEN IN TREATMENT BEFORE?

HAS YOUR TEEN BEEN HOSPITALIZED FOR MENTAL HEALTH OR SUBSTANCE USE?

HAS YOUR TEEN HAD A MENTAL HEALTH DIAGNOSIS?

IF YES TO THE PREVIOUS QUESTION (MENTAL HEALTH DIAGNOSIS), PLEASE PROVIDE DETAIL:

Together, we can bring love back to teens and families, one step at a time.

Let us support your healing and recovery journey

Request your Free assesment today