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Lighthouse recovery washington indiana 2025

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The document is a New Applicant Admission Form for The Lighthouse Recovery Center, Inc., which collects comprehensive personal, medical, and background information from individuals seeking admission to their recovery program. It includes sections on personal identification, family history, employment history, living situation, criminal charges, health status, substance use history, and behavioral agreements. The form emphasizes confidentiality and outlines policies that could lead to immediate removal from the program.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your intake date, room number, and bed number at the top of the form. This information is essential for your admission process.
Fill in your personal details including your name, address, city, state, and zip code. Be sure to provide accurate information as this will be used for communication.
Complete the emergency contact section with the name, address, phone numbers, and relationship of your chosen contact. This ensures that someone can be reached in case of an emergency.
Provide details about your identification including Social Security number and date of birth. This is crucial for verification purposes.
Continue filling out sections regarding your education history, employment status, living situation, and any criminal charges if applicable. Each section is designed to gather comprehensive information about your background.
Lastly, review all entries for accuracy before submitting. Our platform allows you to save progress and return later if needed.

Start using our platform today to complete your Lighthouse Recovery application easily and for free!

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