Apply for Admission

Complete the intake form below to begin your application. All information is confidential.

Prefer to apply by phone? Call 940-232-8252

Note: Submitting this form does not guarantee admission. All applications are reviewed by our Program Director who will contact you to discuss next steps.

Personal

Substance

Medical

Legal

Statement

Review

Personal Information

Full Name *

Phone Number *

Email Address *

Emergency Contact Name *

Emergency Contact Phone *

Desired Move-in Date

Need help with your application? Have questions about the program?

Call Justin Gomez Medrano : 940-232-8252