To ease the admissions process, please review the following documentation, print and complete the required forms and come prepared to your admissions appointment.
1. Pre-Screening Form
2. Download and Print Packing List for Your Desired Program
Required forms include: Screening Form, Intake Packet, Mental Health Screening, Gambling Assessment and Communicable Disease Questionnaire.
Please bring the following information with you to your admission appointment:
- Contact information for anyone you would like Quapaw House, Inc. to communicate with while you are in our care (Required contact info includes: name, date of birth, address with zip code and phone number)
- A copy of your health insurance card, front and back
- A copy of your Driver’s License or ID card
- A copy of your Social Security card
- Your Food Stamp Card
- A copy of your proof of income for the last year (Pay stubs for the last 12 months; Tax returns or W-2 from the previous filing year with pay stubs up to your admission date; SSI check stub or letter; or any other valid form of proof of income)
Specialized Women’s Services Clients must also bring:
- Items necessary for their children, i.e. clothing, food, medication, benefits.
- Children’s Birth Certificates (only those that you are bringing to treatment with you)
Adolescents must also bring:
- Physical within the last 30 days
- Current Shot Record
- Parent or Legal Guardian to sign paperwork