This addiction recovery program discovery form is designed for treatment centers, counselors, and intake teams that need a clear picture before the first conversation. It captures basic contact information, date of birth, preferred contact method, and the main reason someone is seeking help so staff can respond with the right context from the start.
Beyond contact details, the form focuses on key clinical screening questions that help shape next steps. It asks about the primary substance of concern, any additional substances being used, length of use, current frequency, recent use within the past 48 hours, and whether the person has previously sought treatment. That structure makes it easier to identify urgency, prepare for a consultation, and route inquiries appropriately.
The template also creates space for people to explain what concerns them most about their substance use, which can surface motivation, risks, and recovery goals early in the process. As a client intake form for behavioral health and recovery programs, it gives teams a practical starting point that feels organized, respectful, and specific to addiction support services.
