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1 (204) 775-3546

Get Started

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Take the first steps…

The answers you provide on this form enable us to help you get the help you need. Having some information about you before we get in touch means we can be ready with guidance, information and support tailored to your circumstances.

Once you submit your form we will contact you within three business days so you can tell us more about your situation and ask any questions you may have.

If you have questions as you are completing the form or decide that you would prefer to speak to someone in person, please call us on 204-775-3546. Download a PDF of this form.

About this form

Completing this form does not compel you to use our services. We will never pressure you into participating in our program, we will just do our best to support you as you take steps towards recovery.

Please be assured that all information you provide to TRC will be kept confidential, in accordance PHIA guidelines and our Privacy Policy. However, please note that email is not a completely secure form of communication. While Tamarack will handle all enquiries it receives in strictest confidence, the confidentiality of information transmitted by email is not guaranteed.

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About You

Name*
Where do you live?*
This information helps us to identify which, if any, supports might be helpful to you during your stay at TRC.

Message OK?
Message OK?
Email*

Medication

When we contact you, we will ask for a few more details because some medications are not permitted at Tamarack. If you are currently taking medications that we don’t allow we can work with you and your doctor to explore alternatives so this is not a barrier to participating in our program.
Are you currently taking prescription medication for physical or mental health reasons?*

Addiction History

MM slash DD slash YYYY
How frequently do you typically use substances?*
What other addictive behaviours do you currently struggle with or have you struggled with?*

Legal

Safety is our highest priority. In order to ensure the best support for you as well as the safety of the house we ask about legal issues. We’ll ask you more about these when we contact you.
Do you have any:
Criminal Charges Pending*
Outstanding Warrants*
Upcoming Court Dates*
Bail Conditions*

Additional Information

Do you feel that there are any barriers or challenges to you being able to access residential treatment at Tamarack (for example, financial, personal, motivational, mental or physical)?*
Please type your name to indicate your signature.

What happens next?

We will review your form and make contact with you within the next three business days. We respond to everyone who submits a form.

In the meantime, if you have questions, want to confirm that we have received your enquiry or are just eager and motivated to get started with recovery, please call us on (204) 775-3546. We will be happy to take your call.