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 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
New Patient Health Questionnaire
These questionnaires must only be completed by patients ages 16 and older.
Notice of Privacy Practices
Notice of Privacy Practices
HIPAA Authorization Consent Form
Release of Information
Out of State Consent
Pregnancy Consent Form
Suboxone / Sublocade New Patients – Additional Forms
Buprenorphine Agreement
Vivitrol New Patients – Additional Forms
Vivitrol Agreement
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.