Program Requirements and Fees:
I understand that if I complete the recommended level of care at AATC of SHYAS, these will be the program
As a condition of this contract / acknowledge the following items and agree to them.
a.I understand that the cost of the DWI Substance Abuse Assessment will be $100.
b.I understand that it is my responsibility to obtain a copy of the DWI citation that was issued, a copy of the
Blood Alcohol Concentration, and a copy of my DMV driving history prior to my DWI Substance Abuse
Following my assessment I will be referred to one or more services based on the assessment outcome, the diagnosis, and the level of care required. d.I understand that upon my referral to an education or treatment program I have the right to choose a provider of those services. AATC of S&H Youth and Adult Services, Inc. has provided a listing of services that are available locally that also include the NC DWI Services web page
Iunderstand that the following services are available to me at this facility. 1.DWI substance abuse assessment/Clinical Assessment
3.Short-term Outpatient Treatment 4. Longer - term Outpatient Treatment 5.Intensive Outpatient Treatment 6.Individual Therapy 7. Other: f.I understand that my DWI substance abuse assessment is valid for 6 months. If I have not begun the recommended DWI treatment or education within 6 months from the assessment date a new assessment and assessment fee will be required.
I understand that I will receive a base line drug screens as part of the initial DWI assessment. This test will
be conducted at no cost to me.
h. I understand that I will receive drug screens and/or breathalyzers randomly throughout my treatment program. This testing will be conducted in-house at a cost of $15.00 per test. All presumptive positive drug screens will be sent to an outside reference laboratory at an additional cost of $50.00 per test. I understand that my treatment program requires abstinence from alcohol and drugs for duration of the treatment program. To successfully complete my treatment program I must be alcohol and drug free. I j.understand that if I am not able to maintain abstinence from alcohol or drugs I will notify my counselor and discuss treatment modification options. I understand that treatment will consist of individual and/or group sessions. I understand that these sessions cannot be rescheduled and regular attendance is required. I will notify the counselor in advance if I am going to miss a treatment session. I understand that all missed treatment sessions must be made- up at an additional cost to me. I understand that I must attend the treatment sessions on a weekly basis and within the required timeframe, or I will have to re-start my treatment program.
m.I understand that if I am more than 15 minutes late for a group session, that session will not count
towards the treatment/group session required.
n.I understand that all education/treatment programs are absolutely voluntary. If I decide to terminate
education/treatment I will discuss this decision with the staff.
o.I understand that lack of cooperation by a client may interfere substantially with the program's ability to
render services effectively to the client or to others. If such circumstances should occur the education/treatment program may discontinue services to the client. p. I understand that no weapons, alcohol or drugs are allowed on this property. If these items are discovered it is grounds for immediate termination from all services.
q.I understand that threats of violence or violent acts toward others will be grounds for immediate termination from all services.