Application

Thank you for expressing a desire to attend our amazing program!

As an effort to provide services for those suffering from financial hardship, Diamond Tree Recovery has begun providing financial assistance based on a sliding scale and economic hardship.  
If you would like to be considered and apply to see if you qualify please fill out the application below.  

We hope to be able to help you begin a path of hope, healing, health & happiness. 
Warm regards
Diamond Tree Recovery
If you require any assistance with the application process, please call 1-385-888-9624.

DISCLOSURE:  All applications are confidential and for the sole purpose of consideration for a reduction of financial responsibility.
The Diamond Tree Recovery applications will only be shared with the treatment team in order to select the candidate that best fits the criteria.
Financial  aid is awarded based on clinical criteria screening, financial need, commitment level, and availability.
Applicants are subject to all the rules and regulations of the program. Failure to comply with the program may result in disqualification of financial assistance. 

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* 1. Please share why you are seeking treatment and why you feel this program is the best fit for you. Please share what your motivation is for entering treatment. 

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* 2. What is your drug of choice?
Which drugs or medications are you dependent or addicted to?
What medication do you plan on using while in treatment?

**For any drug mentioned please list;
Date of last use, average amount used & how often/how long you have been using that drug.** 

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* 3. Have you had treatment for this condition before? If yes, Where? When? What treatment models/methods have you found beneficial to you?

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* 4. Are you actively suicidal, homicidal, planning to harm self or others, or pending criminal charges of an aggressive nature?

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* 5. When is your ideal start date for treatment?

Date / Time

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* 6. Are you currently employed? Where? Full or part time?
Do you have a certificate or license?

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* 7. Would you be willing to document via video or written testimonial about your experience?

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* 8. Do you have have a home and have support available such as spouse, family, sponsor or friends close to your home?

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* 9. What total out of pocket $ will you be able to invest into your health? 
Please list any outside resources such as; credit availability, family funding, clergy or any other financial support available. 

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* 10. If you have insurance and would like us to bill your insurance please fill out the information below.(Please fill out this question for contact information even if you don't have insurance. Put n/a if not applicable)

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