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Program Responsibilities

Our associates are highly qualified and experienced, and are passionate about the care they provide. Not only will our providers treat your existing conditions, we will also help to create a custom recovery plan that's right for you. We strive to help you improve your quality of life.

 

Please begin with the Enrollment Form. Click submit when finished. A Patient Representative will contact you to complete the enrollment process. Call 877-437-2101 for you have any questions.

All forms are made and processed through 123 Form Builder. Your information is secure, and will only be used for the purpose of building your patient file with Addiction Care 101. View 123 Form Builder’s Privacy Policy here

1.

Enrollment

2.

Medical History

3.

Text Consent

4.

HIPAA Authorization

5.

Authorization to Release 

Healthcare Information

6.

Program Responsibilities

7.

Treatment Contract

8.

Accountability Partner Consent

9.

Relapse Prevention Plan

10.

Drug Abuse Screening

11.

Probation Agreement

Only for patients on probation.

A101 Virtual Group Times

Monday: 7-8pm

Tuesday: 8:30-9:30am | 5-6pm

Wednesday: 10-11am | 5-6pm | 7-8pm

Thursday: 8:30-9:30am | 5-6pm | 7-8pm

Friday: 9-10am | 12-1pm | 3-4pm

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

Phone: 877-437-2101

Fax: 910-399-2190

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