contact us

patient forms

Complete all of our enrollment forms and questionnaires online. Questions? Call 877-437-2101. 

1.

Enrollment

2.

Medical History

3.

Text Consent

4.

HIPAA Authorization

5.

Program Responsibilities

6.

Treatment Contract

7.

Accountability Partner Consent

8.

Relapse Prevention Plan

9.

Drug Abuse Screening

10.

Probation Agreement

Only for patients on probation.

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A101 Virtual Group Times

Monday: 7 – 8 p.m.

Tuesday: 8:30 – 9:30 a.m. | 5 – 6 p.m.

Wednesday: 10 – 11 a.m. | 3 – 4 p.m. | 7 – 8 p.m.

Thursday: 8:30 – 9:30 a.m. | 7 – 8 p.m.

Friday: 9 – 10 a.m. | 12 – 1 p.m.

Dial-in: 1-512-489-3100 Ext. 4820351

877-437-2101

311-4E Judges Road

Wilmington, NC 28405

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