Client Information Submission Forms

Thank you for choosing InnerBalance Health Center for your addiction recovery needs. Here you will find valuable information that will help familiarize you to our services and treatment.

Confidential Assessment Form [Secure Encryption]: Please complete this assessment form prior to your stay with us. This will help us better understand your background and personalize your treatment program to your needs.
Deposit for Program [Secure Encryption]: Use this form to read our deposit policy and submit your online payment securely and confidentially.
(Optional)Pre-Admission : Verify Insurance [Secure Encryption]: If you are unsure about what your insurance company may or may not cover, complete this form and we will help you to verify coverage. We do not accept Medicare/Medicaid

Once you have completed the Assessment Form, please download the following forms to complete your introduction packet.

Download our Welcome Packet: Our welcome packet includes a welcome letter, guidelines for acceptance, information about your deposit and notice to family members.
What to bring for your stay.
  • Casual, comfortable clothing and shoes
  • Clothing you can layer – temperatures fluctuate
  • Exercise clothing and shoes
  • Swimsuit
  • Personal toiletries
  • Hair dryer
  • Day pack – if walking or riding a bike
  • Sunglasses & sunscreen
  • Calling card for long distance phone calls
  • Sleep wear – robe, pajamas, slippers
  • During the winter months, please bring snow boots, gloves, hat, scarf, winter coat, etc. as you will be walking back and forth from our residence to our office. You will also attend an outdoor field trip that requires light hiking outdoors, and weather may vary.
Optional items to bring
If you have the following and would like to bring along:

  • Laptop
  • Cell phone
  • Inspirational reading
  • iPod’s or MP3 players
  • Recreational equipment – golf clubs, tennis rackets, roller blades, fishing rod, playing cards, board games…
  • Camera
  • Stationary, envelopes, stamps
Dress code policy for clients
Please do not wear any of the following during your stay with InnerBalance Health Center

  • Torn clothing
  • Clothing with foul language or obscene images
  • Clothing with images/sayings that are alcohol or drug related
  • Excessively tight or short clothing (shorts need to be mid-thigh length)
  • See-through clothing
  • Bare midriff shirts
  • Exposed undergarments
  • Strapless shirts

If a client’s dress is in violation of this policy, the client will be asked to make an appropriate correction.


Family Program Submission Form

For friends and family that are looking to gain insights and knowledge in helping your loved ones achieve a life of sobriety, we offer an optional intensive 3-day Family Program. Click here to learn more about our Family Program.

Family Program Online Enrollment Form [Secure Encryption]: If you are ready to sign-up and reserve space in our upcoming Family Program sessions, have each family member complete our online form.

AfterCare Opportunities Form

For friends and family that are considering our after care services, please complete the form below.

Family Input and After Care Form [Secure Encryption]: If you are ready to sign-up and reserve space in our upcoming Family Program sessions, have each family member complete our online form.

Financing Options

We offer three flexible financing options to meet most needs.

Apply in minutes and receive an instant pre-approval without affecting your credit.

Apply in less than a minute and receive an instant pre-approval without affecting your credit.

Click the banner and search for your doctor. Then submit the one-page application and get an immediate answer.