Thank you for considering Saltwater Mission as part of your recovery journey. We recognize that reaching out for help can take courage, and we are grateful that you have taken this first step.

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Before completing this form, please take a moment to read the information below. This intake form helps us learn more about you, your recovery journey, your current circumstances, and your goals. Some of the questions are personal and may feel difficult to answer. We ask them because understanding your circumstances helps us determine whether Saltwater Mission is an appropriate and safe fit for you at this time.

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Please answer each question honestly and as completely as you are able. There are no “right” answers. Honest information allows us to have a meaningful conversation with you and helps us understand how we may best support you.

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Submitting this form does not guarantee acceptance into the program. Once your intake has been reviewed, a member of our team will contact you to discuss your circumstances, answer questions, explain the program, and talk with you about the next steps.

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Before You Begin

Please make sure you have enough time to complete the form thoughtfully. You may want to have the following information available:
 

• Your current medications and medical information

• Information about any current or previous treatment

• Details about current substance use

• Emergency contact information

• Information regarding any current legal matters
   

If you are currently experiencing a medical or mental health emergency, are in immediate danger, or require urgent withdrawal or detoxification support, please seek emergency or medical care rather than completing this form.