Please Complete the Following Items PRIOR to your admission appointment:

  • Screening Form
  • Intake Packet
  • Mental Health Screening
  • Gambling Assessment
  • Communicable Disease Questionnaire


Please bring the following information with you to your admission appointment:

  • Contact information for anyone you would like Quapaw House, Inc. to communicate with while you are in our care
    • Information needed for each contact includes: Name, Date of Birth, Address with Zip code and Phone number
  • A copy of your insurance card, front and back
  • A copy of your Driver’s License or ID card
  • A copy of your Social Security card
  • Please bring your Food Stamp Card to your appointment
  • A copy of your proof of income for the last year (Pay stubs for the last 12 months; Tax returns or W-2 from the previous filing year with pay stubs up to your admission date; SSI check stub or letter; or any other valid form of proof of income)


Adolescents must also bring:

  • Birth Certificate
  • Physical within the last 30 days
  • Current Shot Record
  • Parent or Legal Guardian to sign paperwork


Specialized Women’s Services Clients must also bring:

  • Items necessary for their children clothing, food, medication, benefits, etc.
  • Children’s Birth Certificates (only those that you are bringing to treatment with you)