Admissions

Start the conversation.

This is not an application you need to “pass.” It helps us understand where you are, what you are looking for, and whether Ascend may be an appropriate next step.

Take as long as you like. There are no right answers, and you can leave anything blank.

How to reach you

Full name

Age

Phone

City and state

Preferred contact method

Why are you reaching out?

What would you like to change in your life?

What are you tired of?

What patterns or behaviors are currently causing problems?

How long has this been going on?

What you have already tried

Anything you have done before is useful context, not a mark against you.

Select any that apply

Tell us more, if you would like

What matters to you

What matters most to you right now?

What would you like your life to look like?

Is there something larger than immediate relief that you want to reconnect with?

A few questions about safety

These questions help us determine whether Ascend is the appropriate level of support and whether another step needs to happen first. There is no wrong answer here, and nothing you say will be used to judge you.

Do you currently use alcohol or other substances daily?

Is there any possibility you may require medical detox?

Have you experienced a recent overdose?

Are you currently experiencing thoughts of harming yourself?

Have you recently experienced psychosis, mania, or severe psychiatric instability?

Current medications

Current therapist or psychiatrist, if applicable

How did you hear about us?

Anything you would like to add

What you write here goes to the Tikkun Ascend admissions inbox and is read by a person.

Start the conversation.

These are here. Always.

Thank you for reaching out.