Admissions & Intake

Start Your Admissions Process With Confidence

Before admission into Mississippi Family Centers for Addictions, we take time to get to know you and your situation so we can advocate for you and prepare for your arrival.

Call Now For Admissions Help Complete The Admissions Form

There is no need to hide anything. We have been there, and we know what you are going through. Everything you share is kept confidential.

How It Works

A Clear, Supportive Path Into Treatment

Our admissions process is designed to feel structured but not overwhelming. We walk with you through each step so you never feel like you are doing it alone.

Step One: Confidential Call Or Form

You can start by calling our team or completing the admissions form below. We gather basic information about you and your situation.

Step Two: Clinical & Medical Review

Our clinical and medical team reviews your information, asks follow‑up questions, and determines whether our program is the right fit for your needs.

Step Three: Planning Your Arrival

We work with you to coordinate arrival details, discuss what to bring, and answer questions about your legal, medical, or personal needs.

Talk Through The Process Jump To The Admissions Form

What We Ask For

Information That Helps Us Advocate For You

The more complete and honest your information is, the better we can determine eligibility, coordinate benefits, and prepare to support you from the moment you arrive.

Basic contact information and home address
Insurance details, income history, and household information
Substance use history, medical and mental health background
Employment status and any legal considerations

We know these questions can feel vulnerable. Our team treats every answer with respect and confidentiality.

What You'll Need To Share

Preparing To Complete The Admissions Form

It is okay if you do not have every detail in front of you, but having the following information ready can make the process faster and smoother.

Personal Information

Full legal name, date of birth, and contact details
Home address and last four digits of Social Security number
Emergency contact information
Employment status and occupation

Insurance, Income & Background

Insurance company name, phone number, member and group ID
Reported income for the last two years (from tax returns)
Any current or past legal charges or court involvement
History of prior treatment episodes, if any

Admissions Form

Tell Us About Yourself And Your Situation

Please complete as much of this form as you can. There are no right or wrong answers. Everything you share is strictly confidential and used only to support your admissions process.

What To Expect As You Fill This Out

This form mirrors the questions our admissions team will ask over the phone. It helps us understand your needs and how we can best support you.

You can pause and come back if you need to gather information
Honesty helps us provide the best care for your situation
Your answers do not have to be perfect—just truthful

If at any point this feels like too much, you can call us and we will walk through each question together.

Complete Admissions By Phone Stay On This Form

First Name *

Last Name *

Best Contact Phone Number *

Home Address *

Address Line 2

City *

State *

ZIP Code *

Date Of Birth *

Last 4 Of SSN *

Employment Status

Occupation

Insurance Company

Insurance Phone Number

Group ID

Member ID

Name Of Insured

Relationship To You

Are You A Military Veteran?

If Yes, Which Branch?

Last Year's Reported Income

Previous Year's Reported Income

Are You Currently Using Substances And/Or Alcohol? *

If Yes, Please List Which Substances And How Often

Drugs/Substances Of Choice (Include Alcohol)

Last Date Of Use, What Substances, And How Much?

Any Medical Issues, Physical Needs, Mental Health Diagnosis, Behavioral Issues Etc?

Have You Ever Had A Seizure?

If Yes, When And How Often?

Any Past Or Current Legal Charges?

If Yes, What Are The Charges?

Have You Ever Attended Treatment Previously?

If Yes, List Each Treatment Stay And Length Of Stay

Have You Ever Experienced Hallucinations (Past Or Recently)?

If Yes, Please List Them And Their Current Status

Do You Have Any Mental Health Diagnoses?

If Yes, List Them, Current Status, And Any Medications

In Your Own Words, Please Tell Us About Yourself And Your Situation/Story *

Need Help Right Now?

You Don't Have To Navigate Admissions Alone

If the form feels overwhelming or you are not sure how to answer some questions, our team can walk you through it step by step over the phone.

Connect With Admissions Today

We are here to listen, not to judge. Whether you are calling for yourself or someone you love, we will explain options clearly and help you decide on next steps.

Call Now: (855) 699‑9955 Return To The Admissions Form