844-LifeChange (543-3242)
GET HELP. CALL OUR ADDICTION HELPLINE 844-LifeChange (543-3242)

Clinical Assessment Form

2 Methods To Get Us Info We Need In Order to Best Help You

For Lighthouse Network to find the best treatment option(s) customized to your specific clinical and financial situation, we need to get some information about you. Some people prefer to call and speak to someone directly while for others, a better fit is to fill out an online form. Because we know time, energy, stress, and other demands are going on in your life, we have 2 ways of getting us your information.

  1. Call our Helpline, 844-Life-Change (844-543-3242) and speak to one of our Care Guides to open you case.
    Fill out our online Clinical Assessment Form that will be submitted to our Care Guides.
  2. This form is not designed to be diagnostic or comprehensive. I designed this tool to provide the essential information to best determine the right fit for your clinical situation and financial situation.

Doctors, Therapists, and Pastors

Always feel free to call our Helpline to access our Case Management and Placement services. But if it more convenient for you to fill out this form instead, certainly feel free to provide the appropriate information for us to help the person you are caring for get the best treatment.

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  • Basic Demographics

  • Please enter a value between 1 and 99.