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Lakeview Recovery Community Self-Referral Form

Are you an Alberta resident, and do you have an active Alberta Health number? 
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In order to attend Lakeview Recovery Community you must be an Alberta resident with an active Alberta Health Number. Please email admissions at admissions@lakeviewrc.ca for more information.

Please enter your email so we can get in touch.

Section 1: Substance Use History

Primary Substance(s) of Concern: 
2. Frequency of use (past 30 days): 
5. History of overdose?  
6. History of withdrawal symptoms? 

Section 2: Living Situation

1. Where are you currently living?
2. Is your current environment safe and substance-free? 
3. Do you have reliable transportation to the facility?