Understanding that certain rules and requirements are essential to the treatment process and to my recovery, I agree to the following commitments during my participation in the Hope House program
: 1. I agree and understand not to discuss the names, subjects, conversations or situations that I observe in Hope House facilities or shared in the group process. I understand that it is against Federal Law to break the confidentiality of any client at Hope House. 2. I agree not to use mood-altering drugs, including alcohol, street drugs, over-the-counter drugs, (including but not limited to CBD Products, Tiana, AddAll etc.) or any prescription drugs not prescribed to me. 3. I agree and understand that the length of my substance treatment is determined by my progress or lack thereof, not by my Referring Agency. Lack of participation, lack of cooperation or inability to maintain abstinence may negatively affect my recovery or cause me to be discharged from the program according to Alabama Department of Mental Health guidelines. 4. I agree and understand that I will attend a minimum of 1 group/individual session per week and 1 self-help meeting per week. A list of Self-help meetings can be found on the additional resources page of the Client Handbook which will be provided to me at the time of registration. 5. If my referral source requires a specified number of self-help meetings, then I must adhere to their requirements in addition to Hope House's recommendation. 6. I agree to attending regularly and being punctual to the sessions to which I am assigned. If I arrive more than 10 minutes late, I will not be allowed to attend any session unless prior notice is given to the counselor and the counselor approves the tardiness. Absences and tardiness may result in sanctions (as determined by the Referring Agency) or termination from the program (based on treatment team recommendations). 7. I agree to participate in group activities and to be courteous and understanding in my interactions with other group members and participants. This includes not using profanity, being respectful to staff and other clients, and waiting my turn to speak. 8. I agree to submit to voluntary drug screens upon request of Hope House Staff in an effort to support the integrity of the program and verify my commitment to sobriety. I also agree to maintain my participation in the color code drug testing program and understand a missed drug test/dilute is considered a positive result. Positive drug screens may result in consequences from the referring agency or a recommendation for a more intensive level of care from Hope House treatment team. 9. I understand that cell phones must be turned off. At no time may pictures or recordings be made on the premises. 10. I understand that smoking is only allowed off the premises. No chewing tobacco, snuff, or e-cigarettes (including vapes) are to be used inside the buildings or on campus. 11. I understand that no client is to be in any office without a staff member present and that no client is to use office phones without a staff member present. 12. I understand that children and pets are not allowed unless approved by treatment team. 13. I understand that other rules may be added by the clinical staff as necessary for order and safety. 14. I understand that violations of these rules may result in: removal from group, probationary periods, report to the referral source, and/or discharge from the program. 15. I understand that my referring agency will receive my letter of completion after all outstanding administrative, rescheduling and individual/group fees have been paid per the referring agency’s agreement with me. 16. I understand that my therapist is a mandatory reporter and if it is determined that I am a risk to myself or others, it will be reported to the appropriate agency.
Signature of FULL LEGAL FIRST, MIDDLE and LAST NAME with stylus or finger