Adult Treatment Application

In addition to your Treatment Application form, you will also need to complete the following forms prior to entering treatment. Please complete these at your convenience.
COVID Admission GuidelinesPre-Admission ChecklistParticipation AgreementFunding Information form (This is mandatory to complete your applicationConfirmation of Income
Please fill out the form below to complete your application to A New Tomorrow Treatment Centre.
Disclaimer - We will be reviewing application the first week of November

PART A - Information Questionnaire

To be completed by Participant with assistance, as needed.


Finances


Emergency Contact


Education


Cultural Information


Legal History


Housing / Accomodation


Mental and Physical Wellbeing


PART B - Substance Use and Treatment History Questionnaire

Please provide as much detail regarding your substance use history below


Opioids

(e.g. Heroin) Please provide as much detail regarding your substance use history below.


Alcohol

Please provide as much detail regarding your substance use history below


Nicotine

Please provide as much detail regarding your substance use history below


Stimulants

(e.g. Cocaine) Please provide as much detail regarding your substance use history below


Benzos

(e.g. Valium) Please provide as much detail regarding your substance use history below


Other

Anything that doesn't fit the above categories. Please provide as much detail regarding your substance use history below


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.


Social Worker

Please provide social worker details if you'd like them included in planning and supporting your care.


Counsellor

Please provide Counsellor details if you'd like them included in planning and supporting your care.


Mental Health Worker

Please provide Mental Health Worker details if you'd like them included in planning and supporting your care.


Family/Friend

Please provide Family/Friend details if you'd like them included in planning and supporting your care.


Elder

Please provide Elder details if you'd like them included in planning and supporting your care.


Physician

Please provide Physician details if you'd like them included in planning and supporting your care.


Bail/Probation Officer

Please provide Bail/Probation Officer details if you'd like them included in planning and supporting your care.


Other (psychiatrist, psychologist, mentor etc.)

Please provide details if you'd like them included in planning and supporting your care.


Submit your application

If you proceed to intake, further information will be obtained from one of our staff regarding those in your care team.