01Required
Client Demographics
Personal, contact, insurance, housing, cultural, legal, and accommodation information.
Your next step toward care starts here.
Choose an inquiry type to begin. The form adapts to the information needed for insurance verification or a court and justice referral.
Client Inquiry Hub
Choose your secure next step
Admissions & Intake Center
Complete new-client paperwork securely
New client? Start your admissions packet here.
Complete each secure form in a new tab. Your answers and uploaded identification go directly to Heart 2 Heart through Hush Secure Forms and are not stored on this portal.
Please do not email identification or completed paperwork. Use only the secure buttons below. Staff may contact you if additional signatures or documents are needed.
02Required
Client Admission Agreement
Review program terms, rights, responsibilities, rules, refund policy, and treatment consent.
03Required if used
Telemedicine Consent
Consent for remote telemedicine and teletherapy care, including benefits and possible risks.
04As needed
Release of Information
Authorize Heart 2 Heart to release or obtain records for care coordination, legal, or personal purposes.
05Voluntary
Media Release Decision
Authorize or decline use of your image, voice, or likeness. Your services are not affected by your choice.
06Required
Secure Photo ID Upload
Upload clear images of the front and back of a government-issued photo ID through encrypted Hush Secure Forms.
07Under review
HIPAA Privacy Notice
The uploaded notice belongs to a different medical practice. Heart 2 Heart staff will add the correct notice after compliance review.
Our Services & Programs
Comprehensive support beyond treatment
Your partner in recovery and long-term wellness
Programs for adults 18+ led with structure, compassion, and respect.