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Patient Intake

Welcome to Freedom Recovery Center! We're grateful to accompany you on your journey toward overcoming substance use. To streamline your first appointment, please complete and submit the form below.

Once we receive your completed intake along with photo identification, you're all set for your initial appointment. Aegis Toxicology Laboratories will send you an oral swab drug screening kit to ensure compatibility with your prescribed medication. These monthly screenings verify medication effectiveness and monitor for any illicit substances.

Additionally, state regulations mandate monthly counseling post-initial appointment. If needed, our certified CADC counselor is available. Expect a call from us on your appointment day to collect payment and provide telehealth appointment details, which will be sent via text or email. Your first appointment, lasting about 45 minutes, requires video and audio activation per federal regulations.

Join our medication-assisted treatment program for comprehensive care, including life skills, financial counseling, housing referrals, and wellness support. Our trauma-informed team ensures you're supported every step of the way. Thank you for reaching out, and we eagerly anticipate meeting you soon!

Date of birth
Date of last physical

Sliding Fee Discount Application

We recognize the financial challenges that can arise during substance use recovery. Before discontinuing treatment due to financial burdens, consider completing our sliding fee form. To assess your eligibility for our sliding fee program, please download the application here, and provide the following documentation:

  • Current Pay Stubs

  • Last Year’s Tax Return

  • Social Security/Disability Check Stubs

  • Unemployment Check Stubs


Once you have gathered these documents, please submit your application, with your supporting documentation, using the submission form below. We'll review your information promptly to determine the appropriate fee category for you.

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Authorization to Obtain/Disclose Health Information

Ensuring the confidentiality of your health information is paramount to us. If you require the transfer of your medical records to or from our clinic, or if you need us to share your health information with another healthcare provider, please complete our Authorization to Obtain/Disclose Health Information form, which you can download here.


To initiate this process, please fill out the form and submit it using the form below. Once submitted, our team will handle your request with the utmost care and diligence. Rest assured, your privacy and confidentiality will be maintained throughout the process.


Thank you for entrusting us with your healthcare needs. We're committed to facilitating seamless communication between you and your healthcare providers while safeguarding your sensitive medical information.

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