contact us

patient forms

Fill out all of our enrollment forms and questionnaires online. For any questions, call 877-437-2101. 

1.

Enrollment

2.

Medical History

3.

Text Consent

4.

Program Responsibilities

5.

Treatment Contract

6.

HIPAA Authorization

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.

877-437-2101

311-4E Judges Road

Wilmington, NC 28405

addictioncare101 © 2018