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Footprints: Drug and Alcohol Treatment Program

Center for Emotional Health offers services from Footprints at all of our office locations in North Carolina, including Charlotte. Footprints is a drug and alcohol treatment center that helps patients overcome substance abuse.

For patients age 16 and up, we provide outpatient individual therapy, group therapy, addiction therapy for those who have already detoxed, and medication management for Suboxone, Sublocade, and Vivitrol. Please call us to schedule an appointment or learn more about our treatment center. 

Footprints en español

Footprints New Patient Paperwork

Please complete the following forms and submit them to our office. You may complete the paperwork digitally, or print and submit the forms. Printable forms are located at the bottom of the page.

Required Forms
New Patient Intake Form
Complete This Form
Health Questionnaire
Complete This Form
Notice of Privacy Practices
Complete This Form
HIPAA Consent Form
Complete This Form
Release of Information
Complete This Form
Out of State Consent
Complete This Form
Pregnancy Consent Form
Complete This Form
Additional Forms
Buprenorphine Agreement
Complete This Form
Vivitrol Agreement
Complete This Form
Printable Forms

If you prefer to print your forms and complete them manually, please use the forms below. Once you have completed those forms, you may scan and send them to our office at newpatients@cehcharlotte.com. If you prefer, you may fax them to (704) 547-3150.

Suboxone / Sublocade New Patient Paperwork

Vivitrol New Patient Paperwork