Admissions

 

If you or a loved one are ready to receive addiction treatment at Harmony, help starts with a phone call.
Staff is available 24 hours a day, 7 days a week.  A respectful and professional admissions specialist will talk with you about your situation. The best solution will be discussed and we will answer any questions you may have.

 

Every individual seeking treatment for chemical dependency at Harmony will be asked to do a telephone admissions assessment that will take approximately 20 minutes. During this time, clinical information will be gathered and insurance information will be collected or private pay options will be discussed. (Please note: most insurance companies do not have after hours/weekend staff able to quote benefits).  If the potential admission is currently an in-patient at another facility, medical or psychiatric records will be required before the admission can be approved.  Once approved, a date and time for the admission will be scheduled.  While we are not able to accommodate after hours or unscheduled admissions, we can often do “same day” admissions!

 

Note: All Information given is always kept confidential.

 

Admissions Form

 

* Prospective Client's First Name
* Prospective Client's Last Name
* Prospective Client's Email
* Prospective Client's Home Phone (example 970-555-1212)
* Prospective Client's Cell Phone (example 970-555-1212)
* Prospective Client's Address
Prospective Client's Address 2
* Prospective Client's City

* Prospective Client's State
* Prospective Client's Zip Code
Other country than United States? If so, please type in country name.
* Prospective Client's Date of Birth (example 01/02/2003)

* Prospective Client's Gender

* How do you plan to pay for treatment?
* Guarantor's Full Name
* Guarantor's Relationship to Prospective Client
* Guarantor's Contact Phone Number (example 970-555-1212)
Employer
Insurance Company
Insurance Company telephone number for Benefits
Policy ID number
Group number
* Person Completing this form - First and Last Name
* Person Completing this form - Relationship to client
* Person Completing this form - Contact phone (example 970-555-1212)
Referred by (if applicable) Full Name/Agency

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* Required Fields