Admissions Form
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Email *
Full Legal Name *
Every Resident is Presented A Copy of the BHR Policies and Procedures Manual Upon Admission. Is this document being made available to you? *
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Every Resident Has A Right to Privacy and Confidentiality. Please List the Contact Information for Anyone You would Like to Grant A Release of Information: *
Cost of Phase One is $775 in addition to a $100 entry fee. Beach House Recovery Does Not Take Deposits or Issue Refunds. Do You Accept the Financial Terms Associated with Phase One? *
Rent Cost for the second phase of residency is $150/week. Do You Accept these Financial Terms? *
In The Event of a Relapse or other Unplanned Discharge what is your preferred Exit Plan to Ensure Your Safe Arrival at the Next Destination: *
Do You Have Any Known Allergies? *
I Understand That No Individual is allowed more than Two Admission Opportunities and that Residing Locally Upon Discharge will Automatically Disqualify Me.  I acknowledge That I Must Take All of my Belongings at the Time of Discharge: *
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