Alcare Place logo

Your Link to Recovery


Alcare Place Recovery Program Application

Please be honest with your answers. All information is kept confidential. This is an electronic form. It should take approximately 15 minutes to complete the application. When you have completed the application, click submit at the bottom of the page and it will be sent directly to the Alcare Place email inbox. Note: You are not required to have an email account to complete this form.

Skip to content