Before you fill-out this questionnaire, please be sure that you:
have briefly talked with Admissions point person,
have read the Exclusionary Criteria for Admission found on our website
understand that clearance from your primary care doctor is required,
understand that a brief admissions interview and mental health assessment by one of our consulting mental health professionals follows this submission of this questionnaire,
understand that Admissions is triaged and no admissions date is guaranteed,
understand that you have 36 hours to confirm your participation in the program once a date has been sent to you, and
have paid the Admission Processing fee of Php10,000.
Mental Health Evaluation
Confidentiality and Non-Disclosure Agreement
Safety Agreement (non-harm)
Notice of Privacy Practices
Admissions Processing Fee
Please take a few moments to complete this form.
Please tell us about yourself, your needs, and your goals, as well as other details to help us customize your program. Please be specific.