Legacy Home Intake Form

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Intake Process:

1. Client or family calls and completes phone screen with staff

2. Staff reviews history and determines initial eligibility

3. If eligible, the client comes in to see us in person and fill out application to move in

4. If there is no current availability the client will be added to a waitlist

To Contact Us Directly:

Call 864-734-2007

Name of referred individual *

Name of referrer *

Phone number for referred individual *

Phone number for referrer *

Phone number for referred individual *

Email for referred individual *

Email for referrer *

Address of referred individual

Address of referrer

Brief response of addiction concern *

Submit

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