Intensive Registration Part II

PCS INTENSIVE COMMITMENT TO REFRAIN FROM DRUG AND/OR ALCOHOL USE

I commit to not drink alcohol, use drugs other than prescription medications as prescribed, or engage in other compulsive addictive behavior (e.g., sexual, food related, gambling) 72 hours prior to and during my intensive.  If I choose to do either and it is the clinical opinion of PCS that it is adversely affecting my therapy, they may decide to discharge me from their program and refer me to a residential treatment center.   Additionally, if I acknowledge being under the influence of drugs and/or alcohol, or it is their clinical judgment that I am under the influence, they will end the session(s) and medical personnel will be called to evaluate me.   Furthermore, my treatment plan may be changed and may result in termination of treatment with PCS.  I understand that a refund of my intensive and/or individual session costs will not be made as a natural consequence of my choices.

Confirm Full Name of Signer(required)

 

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