DRUG & ALCOHOL TREATMENT INTAKE FORM:

Medically Monitored Detox- 30/60/90 Day Inpatient Programs

Please Fill Out Our Convenient One-Page Intake Form to Begin the Admissions Process.

Call us at 406-453-5080 if you need assistance completing the Intake Form, and our Admissions Team will walk you through the form step by step. You can also scan and email us the form at info@rehabrocky.com, or Fax us the form at 406-727-8172.


You Can Also Submit the Client Intake Form Online. All Information is Kept Secure and Strictly Confidential: