Addiction Treatment Program Information Request Form

Finding the right addiction treatment program is a crucial first step toward recovery. This Addiction Treatment Program Information Request Form helps treatment centers provide personalized information about their programs while respecting the confidential nature of addiction recovery inquiries.

Designed specifically for addiction treatment centers, rehab facilities, and recovery programs, this form template allows potential clients and their families to request detailed information about treatment options in a safe, judgment-free environment. The form captures essential details about the individual's concerns—whether substance-related or behavioral—insurance coverage, preferred treatment approaches, and the best time for a confidential callback.

With Paperform's conditional logic, you can tailor the information gathering process based on the type of concern selected, ensuring you collect relevant details without overwhelming the person reaching out. The professional, compassionate design helps reduce barriers to seeking help while giving your intake team the information they need to provide appropriate resources.

Why treatment centers choose Paperform:

This template integrates seamlessly with your existing systems through Paperform's native integrations. Connect submissions to your CRM to track leads, sync with Google Calendar for callback scheduling, or use Stepper to automatically route urgent requests to on-call counselors and send personalized information packets based on the concern type and insurance coverage.

For centers that need to follow up with consent forms or program agreements, Papersign makes it easy to send eSignature documents directly from each submission, keeping the entire intake process connected and secure.

Trusted by addiction treatment centers, mental health facilities, and behavioral health providers, this SOC 2 Type II compliant form ensures that sensitive information is handled with the highest level of security and confidentiality.