Pre-Registration Form for RSS Services

New Consumer Registration Site


Pre-Registration Form
Please provide us with a working phone number where you can be contacted.

Intake Appointment Type
Please note: The enrolling consumer must be present at a contracted Recovery Support Services Provider location for all telehealth intake appointments.
Please include preferable dates/times for the intake appointment.

Are you a resident of the state of Missouri?
Participants must have state issued identification. Driver's License, State Issued ID, Department of Corrections ID are acceptable forms of identification.
If you do not have identification, please contact our offices before proceeding with this form.
Do you have a copy of your social security card?
A copy of your social security card will be required for the intake appointment.
If you do not have a copy of your social security card, please contact our offices before completing this form.
You may upload the copy of your ID here. Identification will be required for the in-person visit.
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Please upload a copy of the consumer's completed intake packet here.
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