5-Day Treatment Forms
Please complete all forms below to fulfill admission requirements and send them to our secure email, firstname.lastname@example.org by 5:00 PM, EST of the Tuesday prior to treatment week.*
Anything received later than 5:00 pm deems ineligibility for the current month's program and the following month will be pursued.
*Any support signatures that cannot be obtained by submission deadline can be completed upon arrival. All other signatures are required, including a 3rd party witness when requested. A witness can be any individual over 18 who is not otherwise signing the document.
RESEARCH consent forms are located HERE
Have more questions?
For more information, to receive the orientation and registration packet or to get your specific questions answered, please call us at 614.896.8222 or submit the form located HERE. We look forward to talking more with you about this exciting program!