New Client - The Nehemiah Project

Recovery Program - New Client

Please complete the form below in order to schedule an intake appointment for The Nehemiah Project Recovery Program.

Your responses will be delivered to our Intake Director, who will contact you by phone to schedule your appointment.

Name
First Last
Email
Have you read The Nehemiah Project Recovery Program policies?
- Yes
- No
What problem in your life has led to your interest in The Nehemiah Project Recovery Program?
How do you know that you are ready to participate in the program?
Why do you believe that our program will be helpful for you?
Why have past attempts (if any) been unsuccessful in helping you to deal with this problem?
How committed are you to completing the requirements of this program, including attendance at all required classes, workouts, & counseling sessions, and homework completion?