Welcome to Truve Living Homes intake wizard

Click next to begin!
 

General
Tell us about yourself

What is your first name?
Client first name

What is your middle name? No middle name? Move on to the next question.
Client middle name

What is your last name?
Client last name

When is your birthdate?
Client birthdate

What is your race/ethnicity?
Client ethnicity

What is your gender?
Client gender

What is your marital status?
Client marital status

 

Contact Information
How can we reach you?

What is your email address?
Email field

At what phone number can we best reach you at?
Client Number

Street Address:
Client Address

City:
Client City

State:
Client Address

Zipcode:
Client Zip
 

Contacts
Give us a few people that we can reach out to in case of an emergency.

Contact
 

Insurance
Enter your insurance provider(s).

Insurances
 

Medical History
Tell us about your medical history.

When was your last relapse date?

RecoveryHistory relapse Date

What is your substance(s) of choice? Add multiple by clicking in the box and selecting different options

Client substances of choice

Have you been clinically diagnosed with anything? Add multiple by clicking in the box and selecting different options

Client diagnosis

Do you have any health problems? Add multiple by clicking in the box and selecting different options
 Client health problems

problemsWhat kind of meetings do you attend? Add multiple by clicking in the box and selecting different options
Client kinds of meetings attended

What allergies do you have? No allergies? Move on to the next question.
Client allergies
Have you had any of the following tests?

Medical Tests
 
 

Medications
List the medications you are currently prescribed.

Medication
 

Treatment Centers
Tell us about any treatment centers you've previously been admitted into.

TreatmentCenterHistory
 

Client Referral Source
 

Who referred you to us?
Client Referred By
 

Occupancy
 

What facility will you be staying at?
Client facility

What date will you be admitted on?
Date

What is the estimated length of stay?

Client estimated length of stay

Client estimated length of stayWhen will you be discharged?
Date
 

Sober Living History
Tell us about any sober livings you've previously been admitted into.

SoberLivingHistory
 

Employment
Tell us about your employment status.
If you're currently unemployed select "unemployed" under "type"

EmploymentHistory
 

Living Arrangement
Tell us about your living arrangement prior to moving into this facility

LivingArrangementHistory