Follow the steps to complete the Acceptance House Intake Form online.

1. Click the ‘Get Form’ button to access the Acceptance House Intake Form. This will allow you to open the form in an online editor where you can begin filling it out.
2. Start with your personal information. Fill in your first name, last name, and date of birth in the designated fields. Ensure that your details are accurate to avoid issues later in the process.
3. Next, provide your current address and email address. Double-check for any typos to ensure effective communication.
4. You will then be asked about your ethnicity and referral source. Select the options that apply to you from the dropdown menus or list provided.
5. Indicate your intake date and status regarding pending charges. Answer the questions about your criminal history and provide details as requested.
6. Complete the marital status, sober date, and questions related to your employment status. If you are employed, include your workplace information.
7. Detail your drug and alcohol history, including the age of first use and any history of trauma or mental illness diagnosis. Specify any medications you are currently taking.
8. Provide an emergency contact name and their phone number. This is important for your safety and wellbeing.
9. Fill out the section on previous treatments and family history regarding drug/alcohol use and mental illness. This information helps assess your background for better support.
10. Review all provided information carefully for accuracy and completeness. Once you are confident that everything is correct, you can save changes, download a copy, print the form, or share it as needed.

Complete your Acceptance House Intake Form online today to take a proactive step in your recovery journey.