Intake Assessment

Montecatini Intake Assessment

After speaking with one of our staff members, please complete the intake application below. Once you submit the application, we will determine whether or not Montecatini will be able to best meet your needs. If it is determined that Montecatini can be the place where you begin healing, we then make a recommendation for our residential, partial hospitalization, or intensive outpatient care.

If you agree, we will request medical information, labs, and an EKG to be sent to our medical team. Once our medical team clears you for admission, our intake coordinator will contact you to schedule your admission date. Throughout the entire intake process, we are more than happy to answer any questions you may have and we welcome you to meet with our treatment staff or schedule a tour of our center to help you make your decision.​



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If yes, we will need copy of custody agreement.


See extra form and we will need a copy of the court order prior to admission,






















Please list any allergies to food (must provide medical documentation) or non-food allergies:

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Substance abuse history (fill out below where applicable): 



























































































































Please note: Some medications may be altered or withdrawn after your meeting with our Medical Team.





















For the following section of questions, please indicate your behaviors for the last 30 days. If you are currently in treatment, please answer regarding your behaviors prior to entering treatment. 




















































A Dynamic and Vibrant Healing Community
Located in scenic Carlsbad, California, three miles from the Pacific Coast.