Salt Lake City Utah
(801) 261-5790

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Individualized, Professional and Confidential Counseling

Pre-admission Screening Assessment

Required Field

Basic Prospective Patient Information
Name
Street
Phone
City
Email
State
Zip
     

Assessment for appropriateness of admission to Metamorphosis
Are you (18) years old or older?
How did you hear about us?
What is your drug of choice?
What prompted you to inquire about Medication- assisted Recovery?
If other drugs (Please List)
     
How long have you been using Opiate substances?
Months
Years
If less than one year, please check all of the following that apply:
Previous patient of Metamorphosis?
Previous patient at another medication-assisted treatment program?
Recently paroled or released from chronic care facility (6 mon.)?
Fear of relapse?
Pregnant
Unsuccessful attempts to quit on your own?
 

Medication-Assisted Recovery with methadone: Pros & Cons
Pros
Cons

Medication-assisted treatment is proven to be the safest and most effective treatment for narcotic dependence.

However, this treatment is most effective when you participate for a minimum of twelve months and preferably two years or more and engage actively in counseling.

At a stable dose you will not have cravings or withdrawal symptoms.

You can develop a physical dependence on the medication and may need to taper off when leaving the program.

Consistent participation promotes stability in all aspects of life, including employment.

You need to take the prescribed medication every day at the facility in the morning (see our facility hours) and it may be 90 days or longer before you can have take home medication other than Sundays.

 

Medication-Assisted Recovery with Suboxone: Pros & Cons
Pros
Cons

After an induction phase, our physician may begin prescribing a week's worth of Suboxone at a time and can move more quickly to two-week and monthly prescriptions.

However, this treatment is most effective when you participate for a minimum of twelve months and preferably two years or more and engage actively in counseling.

Research suggests Suboxone is easier to withdraw from than methadone, pain killers or heroin.

Suboxone can perpetuate a physical dependency.

For some individuals, Suboxone has been very effective in eliminating all cravings and withdrawals, allowing individuals to feel completely "normal."

Suboxone may not be strong enough to eliminate all withdrawal symptoms and cravings, in which case a transition to methadone may be needed.

You can get prescriptions filled at almost any pharmacy or we may provide it directly, which may be less expensive than a pharmacy.

Unless you obtain your Suboxone from a pharmacy that accepts your health insurance, Suboxone treatment is more expensive than methadone treatment due to the cost of the medication itself.

 

Date you anticipate coming in for admission:
I give Metamorphosis staff permission to contact me if this time can't be accommodated.

All information submitted is confidential. Upon submission of information we will respond with an acknowledgement of receipt. You may also fill this form out, print it off and bring it in with you.

General Admission Information:

Outstanding balances for former patients will be considered before readmission. If the previous discharge was not a planned, mutually agreed upon event, consultation with our physician and program director may be required prior to readmission.

Please plan on up to 3 hours for the admission process (we will minimize the admission process time as much as we possibly can).

For admission, you must bring a current state-issued picture ID to be photocopied. Also please bring your fee in the form of a money order or debit card using your PIN number. Cash, personal checks and non-PIN based credit cards are normally not accepted.



  

Questions?

Contact Us

(801) 261-5790
Fax 801) 261-5794
Email: Metaslc@breakaddiction.org

Metamorphosis Ogden Utah Home

164 East 5900 South, Suite 101
Salt Lake City, Utah 84107
(801) 261-5790|Email