2026 NEW Adult Registration Form PART A - Information Questionnaire To be completed by the applicant with assistance, as needed.
Do you have a fixed address?
Please note A New Tomorrow will contact you via telephone and e-mail. Screening Assessments will be conducted virtually wherever possible.
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Do you self-identify as Indigenous?
Do you have any outstanding charges?
Are you currently on bail?
Do you give consent to talk to your bail supervisor?
Are you currently on probation?
Do you give consent to talk to your probation officer?
Are you currently on parole?
Do you give consent to talk to your parole officer?
Do you have any upcoming court dates?
Have you ever been convicted of a violent offence?
Have you ever been convicted of a sexual offence?
Do you have a history of engaging in sexually inappropriate, abusive, or non-consensual behaviour?
Do you have a history of fire starting behaviour?
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Mental and Physical Wellbeing
Have you ever received a formal Psychiatric Diagnosis for:
If 'other' or if 'Personality Disorder', please describe:
Are you certified under the Mental Health Act?
Do you have an Acquired Brain Injury (ABI) or Traumatic Brain Injury (TBI)?
Do you have Fetal Alcohol Syndrome (FASD)?
Do you have any self-injury behaviours? (i.e. cutting, burning, purging, bingeing)
Do you have any suicidal thoughts?
Have you ever attempted suicide?
Do you have any suspected or diagnosed physical concerns? (e.g. seizures, kidney / liver issues) If yes, please describe.
Are you on Opioid Agonist Therapy (OAT)
Have you been admitted to hospital for any reason in the last year?
Do you have any allergies/dietary needs?
Do you have any barriers to completing activities of daily living (ADLs) health concerns that may impact your ability to participate fully in programming? Let us know if you require specific accommodation.
Specific Accommodations Required
Do you have any mobility issues?
If Yes, please describe mobility issues and if you require any mobility aids.
Do you have any scheduled upcoming medical appointments?
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PART B - Substance Use and Treatment History Questionnaire Please provide as much detail regarding your substance use history below
Have you ever been in a treatment program (including day programs) to get help with substance use?
(e.g. heroin, fentanyl, oxycodone, codeine, morphine, hydromorphone) Please provide as much detail regarding your substance use history below.
Treatment Goal (stop use, reduce harm etc.)
Please provide as much detail regarding your substance use history below
Treatment Goal (stop use, reduce harm etc.)
Please provide as much detail regarding your nicotine use history below
Treatment Goal (stop use, reduce harm etc.)
Please provide as much detail regarding your Cannabis use history below
Treatment Goal (stop use, reduce harm etc.)
(e.g. cocaine, amphetamines, methamphetamine, bath salts) Please provide as much detail regarding your substance use history below.
Treatment Goal (stop use, reduce harm etc.)
(e.g. valium (alprazolam), Xanax (diazepam), Ativan (lorazepam)) Please provide as much detail regarding your substance use history below.
Treatment Goal (stop use, reduce harm etc.)
(e.g. mushrooms, ketamine, PCP, LSD, MDMA, solvents, etc.) Anything that doesn't fit the above categories. Please provide as much detail regarding your substance use history below.
Treatment Goal (stop use, reduce harm etc.)
What are your 3 treatment goals?
Circle of Care Please indicate additional people within your circle of care that you would like to be included in planning and supporting your care.
Parole Officer, Probation Officer, Bail Supervisor
Other (psychiatrist, psychologist, mentor etc.)
Release of Information I authorize A New Tomorrow Treatment Solutions to obtain and/or release oral and/or written information pertinent to my stay and programming at the A New Tomorrow facility.
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Funding Information There is a per diem cost for A New Tomorrow Treatment Solution LTD. of $70 per day for 42 days for a total of $2,940.00.
There are several ways to receive funding
If on an Income Assistance or Person's with Disabilities, an application can be made to Ministry of Social Development & Poverty Reduction. Rent is covered while in treatment (maximum allowable is $375 per month) and a comfort allowance only is issued.
A First Nations person with status can apply to the First Nations Health Authority (Suite 540-757 West Hastings Street Vancouver BC V6C 1A1 Tel: 604-693-3261 Fax: 604-666-3867) or they may be able to approach their band for funding. Confirmation from funder in writing is required.
Self Pay. The applicant must be prepared to pay the full amount 7 days prior to admission. Please review our refund policy below.
Extended Benefits - A New Tomorrow Treatment Solution LTD. requires a letter from the applicant's provider to accompany this application.
Applicants may apply to their health authority through their Case Manager/Counsellor for an Accommodation Fee Subsidy for partial or full payment. See your Case Manager for details
The participant (listed below) will be paid in the following way (please select and fill out the options below)
Please select how you will be providing funding
Participation Agreement I understand that A New Tomorrow is an abstinence-based program and there are expectations regarding my conduct while a participant in the program. I agree to the following:
Please agree to the following
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