SIGN UP for DUII/Other AOD INTAKE SESSION

PLEASE READ BEFORE FILLING OUT THIS FORM: CHECK THE CALENDAR FOR AVAILABLE INTAKE DATES. INTAKE APPOINTMENTS are at regularly scheduled days and times. Please schedule your appointment at least 24 hours in advance. Same day appointments cannot be guaranteed. INTAKES OUTSIDE THE REGULAR TIMES BY APPOINTMENT ONLY. After completing the intake form CALL 503-719-5250 or email info@terasinc.org if you need another time and day.  
For Diversion/DUII clients you do not need to go to the evaluation and referral appointment at *ADES before signing up with Teras if you are entering diversion/probation for a DUII. 
ABOUT OREGON HEALTH PLANS: Some Oregon Health Plan (OHP) Coordinated Care Organization(aka:CCO's) may not pay for treatment at our agency. We are currently accepting all members of HealthShare and FamilyCare CCO's and Open Card  OHP. If your OHP is from Multnomah, Washington or Clackamas County then you have either HealthShare or FamilyCare or what is commonly referred to as Open Card. If you live in another county you may have a different CCO and it may not pay for treatment in this jurisdiction.  
 *Some ADES's may not give you "credit" towards your abstinence time until the evaluation appointment is complete.