ROCKY POINT RECOVERY
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  • ABOUT IBOGAINE
    • HOW DOES IT WORK?
    • HISTORY OF IBOGAINE
    • SUCCESS RATES
    • YOUR SAFETY
    • SAFETY & CONTRAINDICATIONS
  • TREATMENT
    • WHAT WE TREAT
    • PRE-TREATMENT TESTS
    • WHAT TO EXPECT
    • DETOX PROGRAM
    • INTAKE PROCESS >
      • INTAKE QUESTIONNAIRE
      • APPLICATIONS AND WAIVERS
    • PRICING AND FINANCING
    • AFTERCARE
  • ABOUT US
    • WHY US?
    • OUR MISSION
    • OUR TEAM
    • RESOURCES >
      • MORE HELP
    • TESTIMONIALS
    • FACILITY
    • FREQUENTLY ASKED QUESTIONS
  • NEWS/INFO

GET TO KNOW YOU

    This intake questionnaire serves as an opportunity for us to get to know you.  We will forward this information to our doctor and therapists so that they may better assist you in your healing journey. 
    ***PLEASE NOTE - THIS FORM MUST BE FILLED OUT AND SUBMITTED IN ONE SITTING AT THE COMPUTER.  WE CAN ALSO EMAIL YOU THE SAME FORM IF YOU PREFER.
    There are no right or wrong answers and we understand that your life likely has many aspects to it that you feel are not expressed positively.  We ask that you make every attempt to answer truthfully and "look within" wherever possible.  Ultimately, this will be about your healing and restoration.

    PHYSICAL HEALTH

    DRUG/ALCOHOL USE

    MEDICAL QUESTIONS

    MENTAL HEALTH

    RELATIONSHIPS

    SPIRITUALITY

    BEHAVIORAL HEALTH

    WHY?

Submit

please cALL, TEXT OR EMAIL TO let us know how we can help you


Telephone

480-600-8383

Email

RockyPointRecovery@gmail.com
  • HOME
  • ABOUT IBOGAINE
    • HOW DOES IT WORK?
    • HISTORY OF IBOGAINE
    • SUCCESS RATES
    • YOUR SAFETY
    • SAFETY & CONTRAINDICATIONS
  • TREATMENT
    • WHAT WE TREAT
    • PRE-TREATMENT TESTS
    • WHAT TO EXPECT
    • DETOX PROGRAM
    • INTAKE PROCESS >
      • INTAKE QUESTIONNAIRE
      • APPLICATIONS AND WAIVERS
    • PRICING AND FINANCING
    • AFTERCARE
  • ABOUT US
    • WHY US?
    • OUR MISSION
    • OUR TEAM
    • RESOURCES >
      • MORE HELP
    • TESTIMONIALS
    • FACILITY
    • FREQUENTLY ASKED QUESTIONS
  • NEWS/INFO