Application for Residential Admissions

Referral Agency

Drug History

Medical Insurance

Medical History

If it was within 12 months of your release date, please email us a copy or bring it with you upon admission
The Transition House at 3800 5th Street, St. Cloud utilizes a service dog on site.

Psychiatric History


Military History

Income Status

Income Status

Legal History


Marital Status

Living Arrangements

Emergency Contact

Your Goals & Plans