Addiction Treatment Center Admission Form

When someone is ready to seek help for addiction, every moment counts. This Addiction Treatment Center Admission Form streamlines the intake process so your facility can quickly assess eligibility, verify insurance, and secure a bed for individuals in need—without the delays of phone tag or paper forms.

Built specifically for addiction treatment centers, rehab facilities, and recovery programs, this template captures everything you need upfront: personal and emergency contact information, detailed substance use history, medical background, insurance pre-verification details, and real-time bed availability preferences. By moving your admissions process online with Paperform, you reduce administrative burden, improve response times, and create a more dignified, accessible experience for people taking the brave first step toward recovery.

The form uses conditional logic to adapt based on substance type, insurance provider, and urgency level, ensuring you collect only the most relevant information. You can embed it directly on your website, use it as a standalone landing page for PPC and Google Ads campaigns, or share the link via crisis hotlines and outreach programs. Every submission can trigger instant email notifications to your admissions team, and you can connect it to your CRM or case management system using Paperform's native integrations or Stepper to automate follow-ups, bed assignments, and insurance verification workflows.

Whether you specialize in alcohol recovery, opioid treatment, dual diagnosis programs, or holistic rehabilitation, this form helps you meet people where they are—online, 24/7—and move them quickly from inquiry to admission. Trusted by behavioral health providers who need to balance compliance, compassion, and speed, this template is your first step toward a more responsive, patient-centered admissions process.