Programs Inquiry/Interest Form

Information about Alcohol and Substance Use Treatment Programs

Center Recovery offers morning and evening support groups and services to clients Monday through Friday, from 10 AM to 7 PM.

Center Recovery accepts Medicaid, including Managed Care Plans, and private insurance (currently Cigna, GHI, Aetna, Empire Blue Cross Blue Shield, Value Options, and CHCS) in addition to out-of-network reimbursement and sliding scale payment options. Length of treatment is assessed on a case-by-case basis but generally lasts 6-12 months, with the first three months being more intensive.

An intake, psychosocial assessment, medical assessment, weekly individual counseling, and group sessions (3-5 days per week) are required for all participants.

Have you ever participated in substance use treatment services before?

Do you have a history of intravenous drug use?

Have you recently used intravenously?

Insurance Information

Do you have insurance?

Insurance Type

Medicaid ID Number

Medicaid: Managed Care Plan

Private Insurance Type

Member Number

Other private insurance

Insurance Group ID

COVID-19

Are you vaccinated for COVID-19?

People are considered fully vaccinated if they meet one of the following requirements: 2 weeks after their second dose in a 2-dose series, such as the Pfizer or Moderna vaccines, or 2 weeks after a single-dose vaccine, such as Johnson & Johnson's Janssen vaccine

If no, why not?

Please choose the value that best describes your reason for not being vaccinated against COVID-19.

If you selected "Other", please explain

About You

Country of origin/place of birth

Are you more comfortable speaking a language other than English?

Limited English Proficiency

Preferred Language

Do you have any accessibility needs?

Disabilities

What other accessibility needs do you have?

Are you currently pregnant?

Are you an immigrant, refugee, or asylum seeker?

Did you arrive in the U.S. within the last 12 months?

Are you a veteran?

Education and Employment

What is your educational background?

Are you currently enrolled in a school/vocational ed program?

If currently enrolled, what program?

Current Employment

If currently employed, where?

Housing and Income

Expected Household Income This Year

Income Source

Other Income Source

What is your current housing situation?

Other housing situation

In the past 12 months have you used any of the following?

When are you available to speak to an intake specialist? Is there anything else you would like for us to know?

For example, Monday and Wednesday afternoons, 3-5pm.

Mental Health Counseling Eligibility

Hello and thank you for your inquiry!

After reviewing your responses to our questionnaire, it seems you are unfortunately not eligible for our counseling services at this time.

As a reminder, our eligibility requirements are as follows for individual counseling:

1. Community members who are uninsured or have public insurance

2. Community members with private insurance who have an annual income of less than $50,000

3. Community members who are not already engaged in a similar supportive mental health counseling service.

For a list of mental health referrals, please visit our list of mental health resources.

For other questions about our mental health programming, please email: counseling@gaycenter.org