Intake Form – OASIS PDP

OPDP Intake Form

Your Personal Information

Your Name(Required)

First Middle Last

Who is filling out this form?(Required)

Date of Birth(Required)

Your Phone(Required)

Your Email Address(Required)

Email Confirm Email

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Best Time To Call You(Required)

When is the best time for us to reach you via telephone?

Type of service Required

Select the Service Required(Required)

Morning In-Person Intensive Outpatient Program (IOP)

Morning Virtual Intensive Outpatient Program (IOP)

Afternoon Virtual Intensive Outpatient Program (IOP)

Patient Related

Tell us a little bit about why you are seeking services:

Do you currently have any thoughts of harming yourself or others?(Required)

Yes

IF YES, PLEASE CONTACT 911 IMMEDIATELY OR GO TO YOUR LOCAL EMERGENCY ROOM.

Are you seeking treatment for alcohol or drugs?(Required)

Yes

How did you hear about us:(Required)

Insurance Company:(Required)

Member ID(Required)

This field is for validation purposes and should be left unchanged.

Your Recovery Process: What to Expect

A Structured Approach to Your Recovery

Fill Out Intake Form

Our staff will verify insurance details and contact you within 24 hours to schedule an Intake Assessment. This ensures a smooth start to your treatment process.

Intake Assessment

Meet with a clinician to evaluate your needs and determine the appropriate level of care. This initial session helps us understand your goals and challenges.

Assessment & Treatment Planning

Begin your program, complete a biopsychosocial assessment, and create a treatment plan with your providers.

Medication & Treatment Evaluation

Meet with our psychiatry team to assess medication needs or explore alternatives like TMS or Spravato.

Start Group Therapy

Join group therapy sessions tailored to your individualized treatment plan. These sessions provide peer support and help develop coping strategies.

Start Individual Therapy

Attend weekly sessions with your clinician or case manager for psychotherapy. This allows for ongoing personal growth and progress in treatment.

Family Involvement

Participate in family meetings and psychoeducation to support you and your loved ones. Strengthening family relationships can enhance your overall recovery.

Discharge & Follow-Up

Schedule follow-ups with providers or get connected to new ones for continued care. This step ensures long-term support and stability after treatment.

One-Month Check-In

Your clinician or case manager will follow up to review your progress. This check-in helps address any challenges and reinforce positive changes.

Your Personal Information

Type of service Required

Patient Related

Your Recovery Process: What to Expect

A Structured Approach to Your Recovery

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