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:

Birth Certificate

  • Physical within the last 30 days
  • Current Shot Record
  • Parent or Legal Guardian to sign paperwork