Thank you for taking an interest in Riviera. Please complete the following information as
completely as you can and email the attached pages to our offices:
Once we receive this information, we will conduct a candid appraisal of the appropriateness of the applicant for Riviera. The accuracy of the information given here will help us in effectively understanding the applicant. Keep in mind, that this is a screening application, designed to gather information in an expedient, yet thorough manner. Following admission, we may need your cooperation in requesting additional information. All applications are reviewed within 24-48 hours and appropriateness is determined.
Admission Criteria: At the time of the physical admission to Riviera, staff will do an assessment
to ascertain whether or not the applicant is physically and mentally suitable for admission. Riviera does not provide on-site medical, psychiatric stabilization or detoxification services. Should such services be needed, we have several places that we work closely with that can be utilized to provide such a service. Any such services are extraordinary and will be covered outside of Riviera fees and tuition. We can coordinate admission to such places.
Riviera can accommodate an applicant that has not completed a primary treatment program
and once the person enters our program they must remain abstinent, except for prescribed medications. Riviera is a voluntary program for young adults that have the legal rights to make their own decisions and determinations. If the applicant is recalcitrant, refusing and unwilling to participate in the program at any time during their stay or relapses into drug and alcohol use, Riviera reserves the right to immediately discharge the applicant. At that point, we assume no responsibility for transportation, monitoring of the client or arrangements to another facility.
Forms of payment: We accept wire transfer, checks, cash and most major credit cards (Visa,
MasterCard, American Express, & Discover).
How do I get them there? In some of the cases, our young adults seek us out. However, we understand the nature of young adult addiction and recovery, which is our primary expertise. We have relationships with experts in the field in intervention, primary treatment, transportation and in regards to many other situations. Our admissions counselors can help you devise a plan to benefit your particular situation. Give us a call.
PARENT/GUARDIAN/FINANCIAL SPONSOR (Primary)
Reason For Referral
APPLICANT HISTORY AND BACKGROUND
Describe any work history and if there are any particular vocational interests:
PREVIOUS INVOLVEMENT WITH PROFESSIONALS
Do you have a sponsor?
EMOTIONAL/MENTAL HEALTH INVENTORY
Please check any of the following that apply to the applicant:
Does the applicant exhibit any of the following unusual behaviors?
Describe any mental health diagnosis given by licensed Mental Health Professionals:
DRUG AND ALCOHOL USE
To the best of your knowledge, please complete the following use history:
Hallucinogens (PCP, LSD, Angel Dust, etc.)
Inhalants (gasoline, paint, glue, etc.)
Stimulants (cocaine, crack, methamphetamine, etc.)
Opiates (heroin, methadone, etc.)
Depressants (sedatives, barbiturates, etc.)
CURRENT SOBRIETY LENGTH
OTHER ADDICTIVE PATTERNS