Home
About
- New Patients
- Polices
Services
Referrals
Locations
Contact

Home
About
- New Patients
- Polices
Services
Referrals
Locations
Contact

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New Patients

Below are a list of links to forms you will need to fill out and sign before we can schedule an appointment. Please complete the patient intake form and Consents. Once completed you will be contacted to schedule an appointment.

Start Your Forward Journey Today

CRISIS LINE

988 Emergency 911

Name*

Preferred Name*

Birth Date*

Phone*

Email*

Social Security Number*

Client is a Minor*

Yes

No

Sex at Birth*

Male

Femal

Street Address*

Apartment

City*

State*

Zip Code*

Emergency Contact Name*

Relationship to Client*

Emergency Contact Phone Number

Insurance Carrier (write none if client does not have insurance) *

Member or Policy Number (Write none if client does not have insurance)*

Group Number*

Subscriber Information*

Subscriber is Client

Subscriber is other than client

Requested Services*

IOP intensive outpatient

PHP Partial Hospitalization Programing

Sober Living

Best way to reach you*

Any

Phone

Email

Text

Best Day of The Week to Schedule an Appointment*

Any Day

Monday

Tuesday

Wednesday

Thursday

Friday

Best Time of Day to Schedule You*

Any Time

Early Morning (8-10am)

Late Morning (10pm-12pm)

Afternoon (1pm-5pm)

Evening (5pm-7pm)

Additional Information (Optional)

FOLLOW US

CONTACT

PHONE

Copyright © 2026 Forward-Recovery, formerly Highlands Roadway to Recovery| All Rights Reserved

HOURS

1634 N 3rd St

Terre Haute, IN 47803

rthomas@Forward-recovery.com

EMAIL

LOCATION

MON-FRI

9am-6pm

SAT-SUN

By Appointment