Program and Services Referral Form

  • Court Information

  • Attorney Information

    (Fill out only if reports are to be sent to attorney
  • CLIENT'S PROGRAM REFERRAL

  • You have been referred to a Reality Check Weekend or Day Intensive Program , or a Service.
    Call Bright Outcomes LLC at (231)938-2999 to be scheduled. Bright Outcomes LLC reserves the right to alter program scheduling as is necessary.
    Cost of Programs
    Reality Check Weekend Intensive $ 300.00
    Reality Check Day Intensive $ 150.00
    Reality Check Web Weekend Intensive $ 275.00
    Reality Check Web Day Intensive $ 135.00
    Cost of Services:
    Substance Abuse Assessment $ 110.00
    Individual Substance Abuse Therapy $ 90.00
    Group Substance Abuse Therapy (Minimum 3 in group) $ 35.00
    Registraton and payment in full 14 days prior to class. Payments Accepted: Certified Check, Money Order, Credit Card
    This is to certify that I am participating voluntarily in a Reality Check Program or Services.
    I understand the court will be informed of my completion of the program. I understand the court will be informed of my
    completion of the program
  • Date : 09/24/2017