Here’s what to know and what to fill out before starting substance abuse treatment.
The forms, policies, and procedures on this page will be given to you while in outpatient treatment. We also provide them here for easy access and to give you the opportunity to fill the forms out before your initial visit.
If you have any questions or concerns about any of these materials or addiction recovery, please do not hesitate to call our patient access center.
DOCUMENTOS EN ESPAÑOL
KENTUCKY NEW PATIENT ENROLLMENT FORM
MARYLAND NEW PATIENT ENROLLMENT FORM
OHIO NEW PATIENT ENROLLMENT FORM
VIRGINIA NEW PATIENT ENROLLMENT FORM
NORTH CAROLINA NEW PATIENT ENROLLMENT FORM
ADDITIONAL FORMS
- Adult Consent for Assessment and Treatment
- Confidentiality Agreement
- Consent for Drug Screen
- Consent for Release of Confidential Information (Complete with digital signature)
- Informed Consent
- Informed Consent for Justice System
- Notice of Privacy Practices
- Pregnancy – Patient Consent for Treatment
- Treatment Contract
- Consent for Release of Confidential Information (Print and fax)
- Record Request Form (Complete with digital signature)
- 42 CFR Part 42 (PDF)
- Patient Guest Dose Inquiry Form
- Guest Dose Request Form (Sending Clinic) – to be completed by primary clinic
BRIGHTVIEW POLICIES AND PROCEDURES
- Patient Code of Conduct
- Patient Financial Responsibility Policy
- Resolver Reporting for complaints or grievances
- 24/7 reporting line: 855-880-0009
MEDICATION ASSISTED TREATMENT EDUCATIONAL INFORMATION
WHAT TO EXPECT FROM US VS. DRUG REHAB
WHAT TO EXPECT FROM US VS. DRUG REHABThis is what your addiction treatment program at BrightView will look like.
START FEELING BETTER TOMORROW.
If you’re ready to regain control and start a personalized medication assisted treatment program that works, we’re only a phone call away.
