Admission Requirements and Criteria
Please complete the following information as thoroughly as possible. This will assist us in determining the appropriateness of our program for the candidate. Our program provides the services necessary to assist each person in transitioning to successful living in recovery free from active addiction. Should you be accepted, the accuracy of the information in each section of this application will help us to effectively understand the needs of the applicant. FIR ( abbreviation for Footprints In Recovery LLC)
Primary diagnosis needs to be substance abuse. It is understood that upon physical admission to Footprints In Recovery LLC., the admitting staff will do an assessment to ascertain whether or not the applicant is under the influence of any drugs or alcohol via urine drug testing and/or breathalyzer. If you are leaving a detox program, we will need your discharge papers with the medical files relating to your medications, discharge summary diagnosis, medications etc. prior to admission. If you have a primary care physician, FIR will require an authorization of your medical history with any current medications. FIR is neither a medical facility nor detox. In the event the applicant does not meet the criteria for immediate admission, we will require immediate transportation to a medical facility for detox evaluation. Detox fee will be the responsibility of the clients and is separate. FIR, assumes no responsibility for transportation, monitoring, or making arrangements for medical care prior to admission. We will however, assist with transportation from Detox facilities If required. Additionally, it is understood if the applicant/resident is recalcitrant, refusing care, or not following the rules or is unwilling to participate in the program at any time during the residency, FIR reserves the right to immediately discharge the client. FIR assumes NO responsibility or liability for transporting, monitoring, or making arrangements for transfer to another facility or to home. FIR is a voluntary program for adults that will challenge them to participate in the recovery process. If you leave the facility voluntarily or involuntarily, our policy states that you will NOT be given a refund in part or whole, however, you have 3 months in which to return to the program to complete your remaining time, providing bed space is available and subject to additional charges based on current rate at time of admission
We require, prior to admission, a $1,000 dollar non- refundable bed hold which is credited to the price of your program and is valid for 7 days. We are committed to this process and the integrity of our program. Upon completion of the application please fax to 252-441-8248 or email to
Admission Requirements and Criteria
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Footprints In Recovery Guidelines: I am committed to participate in Footprints In Recovery Program and agenda and recognize that this is not a medical facility. I am committed to keeping my living space neat, clean and tidy. I am committed to dressing appropriately. I will actively participate in and do my share in weekly schedule of maintaining household chores of the common areas of both the counseling center and the Recovery house. Occasionally FIR is involved in volunteer work to assist others and other organizations in the community and you will be asked to actively participate with this as well. I am very aware that these activities are based on a process to encourage me to learn and implement life skills of cooking meals with others and cleaning areas utilized. I will be courteous in my manners when interacting with others. I will not intimidate, threaten or disrespect staff or clients. I will be prompt to all meetings and appointments. I clearly understand that to remain at FIR, I must remain sober and drug free. I am committed to doing my best in every area of recovery and participation. The consequences for not complying with any of these guidelines can be immediate discharge from Footprints In Recovery.
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Client signature and date Guarantor signature and date
Update 7/13