Addiction Assessment & Application Form

Financing for Rehab

Addiction rehab financing options are available to those who qualify. Please visit American HealthCare Lending for more information and to apply online.

Healthcare provider: 004350

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Name
Does the addict want help?
How does the addict obtain drugs/alcohol?
Can the addict travel?
Is the addict on any medication for any of the above?
Has the person ever attempted to stop using drugs before?
If so, by which method?
Was it a private program or a state-funded program?

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+1 866.540.4742

5280 Lonesome Hawk Dr
Prescott, AZ 86305

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Dr. Kenneth Chance

928-288-2004

The MONTANA Model

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