The Right Step 1-87-SOBRIETY
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We provide the following services for the treatment of drug addiction and alcoholism:
The following forms and features have been developed to better serve your needs:

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In addition to the quality, affordable treatment provided by The Right Step, we offer exclusive private recovery at Spirit Lodge where guests enjoy panoramic views of the hills outside Austin and individualized care in 5-star accommodations. Watch our video.

Admission Form


PERSON COMPLETING THIS FORM
Full Name*
Email*
Home Phone*
Work Phone*
Cell Phone*
Date of Birth
Program of Interest*

APPLICANT
Name*
Nickname
Address*
Address 2
City*
State*
Zip*
County
Country*
Home Phone*
Work Phone
Cell Phone
Male/Female*
Date of birth*
Race
Marital status*
Education level
Employed*
Legal status*

SERVICES & LOCATIONS
I am interested in*
The Right Step location best suited to my needs is*

EMERGENCY CONTACT INFO
Name*
Relationship to applicant*
Address*
Address 2
City*
State*
Zip*
County
Country*
Home phone*
Work Phone
Cell phone

REFERENT (If applicable)
Name
Title
Agency
Relationship to applicant
Address
Address 2
City
State
Zip
County
Country
Home phone
Work Phone
Cell phone

GUARANTOR
Guarantor
That person's name*
Relationship to applicant*
Date of birth
Address
Address 2
City
State
Zip
County
Country
Home phone*
Work Phone
Cell phone

FINANCIAL INFO
How do you plan to pay for treatment?
(If insurance)
Insurance Co.
Group #
ID #
Insurance phone
* required fields

Privacy is paramount at The Right Step

In compliance with federal privacy & confidentiality laws, The Right Step is bound by law, never to release names, email addresses or postal addresses to any third party. Your privacy is of critical importance to us. This is our pledge.
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