Patient Transfer Form

We are happy to hear that you would like to transfer to one of our treatment centers and look forward to serving you.

In order to complete the transfer process, please contact your current Counselor to advise them of your request so that they can support you with the proper paperwork to transfer to our treatment center. This is a requirement in order to transfer to an new treatment center.

If you have any questions for us regarding the transfer process, please fill out this form and a member of our treatment team will get back to you asap. Please include an email and phone where we can reach you to answer your questions. Thank you.

First Name *

Last Name *

Email *

Phone *

Select the New Season Treatment Center you want to transfer to *

Effective Transfer Date

Select the New Season Treatment Center you want to transfer from *

Enter non-New Season Treatment Center transferring from

Current treatment center phone number *

Current treatment center fax number

Message

Patient Transfer Form

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