Options Okanagan Drug Rehab Center in BC Drug Rehab Intake Form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Client's Personal Information section. Enter your name, address, city/town, province/state, postal code, phone number, cell number, email address, birth date, and intake date.
3. Next, provide your Health Card Number and details for an emergency contact including their relationship to you and their phone numbers.
4. In the section regarding your understanding of the length of stay, provide a brief explanation of your expectations.
5. Answer questions about your last substance use: specify when you last used, what substances were involved, and the quantity consumed.
6. Review the Agreement of Responsibility section. Confirm your agreement to pay the bed deposit by filling in your printed name and signing where indicated.
7. Finally, choose your form of payment by indicating whether it will be a direct deposit or credit card. Fill in the necessary credit card details if applicable.

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