Schedule an intake/induction online!

You can also call 719-283-9097 to schedule your intake!

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* Patient Information:

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* Appointment Date (MM/DD/YY):
(Monday - Friday)

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* Appointment Time:

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* Clinic Location:

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* Would you like us to email you a link to sign consent forms digitally (Docusign) before your appointment?
(Note that all consents will be reviewed with you in detail during your intake appointment with a counselor)

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* How did you hear about us?

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* AGENCY REFERRALS ONLY:   

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* Notes/Comments:

WHAT TO EXPECT AT INTAKE:

A.   Plan to be at the clinic for about 2 hours on the day of your intake
B.   You will not be allowed to leave once you start your intake, so please plan accordingly
C.   You will need to provide us with a urine sample once we start your intake
D.   You will meet with a nurse, medical provider, and counselor at your intake
E.   You will dose at the end of your intake, once you've been cleared by the state
WHAT TO BRING:

1.   Photo ID
2.   Payment method
          a.  either Medicaid # or debit card/cash to pay for intake fee plus daily dose (approx. $37).
3.   List of all medications
4.   Optional: 
           a.  A light sweater in case you get cold easily. Dressing in layers is recommended. 
           b. New Patient Consent Forms (on website)

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