General admissions criteria includes women, ages 18 and older, in need of drug/alcohol addiction treatment. Any need for detoxification should occur prior to admission to our Program. All Participants must be willing. Admissions Criteria Verification Form Name of Person Completing Form or Making Referral * Relationship to Person in need of Addiction Treatment * Contact Phone # * Email * Name of Person Seeking Drug/Alcohol Treatment Services * Date of Birth * Current Full Address of Residence * Responsible for Self or Guardian? * If you are human, leave this field blank. Next Δ
