One Step

Recovery Center of the Ozarks Application

Thank you for your interest in applying to RCO.

Recovery Center of the Ozarks is a non-profit organization focused on providing pathways of hope for those seeking a journey out of substance use disorder while reclaiming their life and reengaging in society.

The holistic approach of recovery translates not only mentally and physically but aims to strengthen a person emotionally, spiritually, financially, socially and intellectually to improve an individual’s quality of life while building recovery capital for the future.

Each individual in RCO’s program willingly builds a new sense of purpose driven by accountability, self-respect and responsibility highlighting a positively changing identity grounded in the principles of honesty, integrity and selflessness.

A better life centered in recovery awaits!

Click next to begin!

General

Tell us about yourself

What is your first name?

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

What is your last name?

When is your birthdate?

What is your race/ethnicity?

What is your gender?

What is your marital status?

Are you a veteran?

Contact Information

How can we reach you?

What is your email address?

At what phone number can we best reach you at?

Street Address:

City:

State:

Zipcode:

Contacts

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

Contact #1
name:
phone:
email:
type:
Contact typeDon't see the option you're looking for? Click here
notes:

Insurance

Enter your insurance provider(s).

Insurance #1
Client insurance provider:
Client insurance plan:
Client insurance group ID:
Client insurance policy #:
Client insurance other:

Medical History

Tell us about your medical history.

When was your last relapse date?

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

Substances of choice

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

Diagnosis

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

Health Problems

What kind of meetings do you attend? Add multiple by clicking in the box and selecting different options

Substances of choice

What allergies do you have? No allergies? Move on to the next question.

Have you had any of the following tests?

Medical Tests #1
type:
TypeDon't see the option you're looking for? Click here
performed_on:
notes:
result:
ResultDon't see the option you're looking for? Click here

Medications

List the medications you are currently prescribed.

Have you ever or are currently using suboxone?

Sober Living History

Tell us about any sober living places or treatment centers you've previously been admitted into.

Employment

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

Employment History #1
Employer name:
Employment position:
Employment income:
Employment incomeDon't see the option you're looking for? Click here
Employment started:
Employment ended:
Employment type:
Employment typeDon't see the option you're looking for? Click here
Employment notes:

Living Arrangement

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

Living Arrangement History #1
arrangement:
Living arrangementDon't see the option you're looking for? Click here
started:
ended:
notes:

Final Questions

Do you have a driver's license?

Do you have a social security card?

Do you have your birth certificate?

Can you pass a drug test? This will not affect our decision to accept your application.

Do you have any gang relations?

Do you have a vehicle?

If yes, Make/Model? Make/Model

Do you have valid vehicle insurance?

Do you have any pending criminal charges? If yes, please explain.

Why are you pursuing Recovery Center of the Ozarks?

What are your biggest concerns about entering into a recovery program?

Thank you for completing the application.

Recovery Center of the Ozarks looks forward to speaking with you and will be in touch at the phone number or email you provided. Until then, keep your head up and know that a life absent of substance use is possible and the resources exist in your area to provide you all the help you need to recover.