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📞 (908) 769-4700 | 519 North Avenue | Plainfield, NJ 07060

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Admissions

Intake Process

PLEASE SEE OUR RECENT UPDATE FOR INTAKE PROCESS, MEDICATION, AND SCHEDULE DUE TO COVID-19.

Call (908) 769-4700 ext. 2103 and/or ext. 2021

Telephone Screening To Determine Eligibility
Assessment By Certified Physician And An Addiction Counselor
Complete Physical
In-House Toxicology Testing
Methadone and Buprenorphine Prescription Management And Monitoring
Multi-Cultural Counseling (Spanish/English)

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

How do you identify your gender *

Date of Birth *

Monthly Household Income *

Employed *

Yes
No

Medicaid *

Yes
No

Medicare *

Yes
No

Do you have any symptoms related to COVID-19? *

Yes
No

Have you been tested for COVID-19 in the last 30 days? *

Yes
No

Are you seeking *

Buprenorphine
Methadone
None

Additional Information

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© Copyright Organization For Recovery
519 North Avenue | Plainfield, NJ 07060
Ph (908) 769-4700 | Fax (908) 769-8833

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