Resources

Application and Forms

The first step to getting into one of our programs is to fill out the required forms in our Application Packet. 

Personal Response Form – Assessment Application [link here]. 

This form must be filled out prior to getting an assessment.  There are a lot of questions in this form, and some may be emotionally painful to think about.  Please do the best that you can to thoughtfully and honestly share your answers.  Your answers are kept confidential and will be reviewed by a licensed clinician for the purpose of getting to know you better and figuring out what services or programs would be the best fit for you.  If you are a fit for one of our programs, we will contact you to arrange for an appointment for a full behavioral health assessment with one of our trained providers.  If you aren’t, we will still contact you and share our recommendations for what would be the most helpful for your needs. 

“An assessment is when helpful people who have big hearts take their time to find out how they can help.”  - Former Serenity House Client

Treatment Goals Form [link here]

We want to hear from you about what your personal goals for treatment and counseling are.  We will use the answers you provide here to help us as we come up with a personalized Treatment Plan for you. 

Medical Assessment Form [link here]

If you are accepted to Serenity House as a residential client, you must have a completed Medical Assessment by a medical provider within the last 30 days to determine whether you are medically stable for admission.  This includes a TB test.  Please print out this form and take it to your medical provider.  Bring the completed form back to our Intake Office in Soldotna, or fax it to us if you live out of the area. 

CSR [link here]

This form is required by the State of Alaska and is used to anonymously measure the quality of your life before, during, and following treatment.  If you remain in treatment with us for any length of time, you will see this form again, as we have all of our clients fill it out every 90 days.  We like to keep up on the progress you are making in treatment, as that way we can continue to provide you with the best care for your specific and unique needs! 

What to Bring to Serenity House [link here]

Click here to learn what to pack (and what not to pack) for your stay at Serenity House. 

Release of Information Form [link here]

Unless you give us permission to do so, we are not able to confirm or deny your presence in our program or treatment center.  A Release of Information (ROI) is the form that you fill out if you would like us to be able to communicate on your behalf with important people or agencies that you are involved with.  This can include your spouse or family member, your previous counselor or treatment program, your doctor, your emergency contact, and/or legal entities that you may be involved with (such as your attorney, employer, probation officer, ASAP, judge, or OCS caseworker).  Please fill out an ROI form for each person or agency that you want to be involved in your treatment program. 

Additional Forms for Residential Treatment [click here]

The following forms are required to be read and signed for all clients who are entering our residential program.  This includes our Patient Rules and Regulations, Client Bill of Rights, Confidentiality of Alcohol and Drug Abuse Patient Records, Financial Policy, and Proof of Income Checklist.

Client Forms and Information

 

Client Intake packet.pdf

Drugs of Choice.pdf

Medical Assessment Form revised 2-2016 MD.pdf

Nutritional Screening.pdf

Packing list.pdf

Personal Goals for Treatment.pdf

Pre-Registration Form 2011.pdf

SHTC Section 1 Inquirer Packet.pdf

SHTC Section 3 Rules Regs and Rights.pdf

SHTC Section 4 Release of Information-REVISED 2012.pdf

 Serentiy House Treatment Center is a Preferred Provider for:

 

• Aetna

• Blue Cross Blue Shield

• CPH Self-Insured Plan

• First Choice PPO

• GEHA/PPO USA

• NPPN/Multiplan PPO Network

• MODA

• Three Rivers Provider Network

• Viant/Beechstreet PPO

• Medicare/Medicaid

• Kenai Peninsula Borough

• Kenai Peninsula Borough School District