CLIENT INTAKE | Beachview Treatment

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Use tab to navigate through the menu items.

What is your full name?

Last Detox/Residential Completed

Are you Currently in a Program?

Sobriety Date?

What is your drug(s) of choice?

Any Current Medications?

Any past mental health diagnosis?

Any past overdoses? When was your last one?

Do you have a history of seizures?

Any History of suicidality/self harm?

Any Major Health Concerns

Current Legal Issues?

Are you currently on parole/probation?

THANK YOU, WE WILL BE IN CONTACT SHORTLY!

REACH US

" Licensed and Certified by the State Department of Health Care Services”

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