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CASE MANAGEMENT FORM

To help us provide you with the best care possible, we kindly ask that you complete our Case Management Form before your visit. This form gives our team important information about your health history, current needs, and any concerns you'd like to address. By filling it out ahead of time, you'll help us make your appointment more focused, efficient, and personalized to your care. Thank you for helping us prepare for your visit!

CASE MANAGEMENT

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Addiction may affect various factors of an individual’s life; case management combined with therapy promotes patients to fully integrate into society as a healthy, substance- free individual and promote recovery. Our case management and counseling services are designed to motivate

and engage appropriate treatment services based off the level, intensity, and supportive services recommended to enable individuals to maintain long term sobriety while also managing life in their community. Your treatment with us will be individually structured to increase response to

factors threating your sobriety, avoiding gaps in services, and implementing various forms of care; applying case management services can help accomplish all the above. Case management is a part of the service that we provide, and we will address to see if you are interested in additional resources that we offer throughout your treatment with us. Below is an outline of the expected follow up schedule for offering, reviewing, and implementing case management services:

  • Induction Phase of Treatment

Once a week for the first four visits


 Stabilization Phase of Treatment

 Maintenance Phase of Treatment:


Patients in the maintenance phase of treatment for less than one year will be offered case management monthly.

services every other month.

 Case Management services:

o Housing (if experiencing homelessness)

o Alcohol & Other Drug Treatment (Intensive Outpatient Programs, Rehabilitation,

Detox, Half-Way Housing, etc.)

o Mental Health (referrals to therapist pertaining to mental health needs that is

outside of our scope of care, Psychiatrist, Psychologist, Nurse Practitioners, etc.)

o The counselor may also recommend additional resources that are not listed that

will help safeguard your recovery as well.

By signing below, you acknowledge that case management was discussed and aware of the expected follow up schedule.

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