Turning Point - Request for Services
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Email *
Legal First Name *
Legal Last Name *
Date of Birth? *
MM
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DD
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Gender? *
Which of the following do you need? *Must be in a treatment program to qualify for Housing* *
What Insurance do you have?
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Social Security Number?
Phone Number? *
Have you been required to register as a sex offender or have current charges pending? *
Do you have a record of any violent offenses or have current charges pending? *
Please list all substances you have used in the last 30 days *
Last date of usage? *
MM
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DD
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How did you hear about Turning Point Behavioral Services *
I understand that Turning Point Behavioral Health has to verify my answers in order to be admitted to services.

I consent to verification of my sex offender and violence history. 
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Web Submission *
Required
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