Application Kit – On-line Form

At the Onen’tó:kon Healing Lodge, we strive to make access to our treatment programs as straightforward as possible. Please refer to our intake schedule as you complete the application form below to let us know which session you would like to attend. You must fill out this form completely, however, once we receive it, there will be other information we require. This form can be completed on your PC or on a tablet. Once we receive the form we will contact you using the information you provide.

Download our In-Take Schedule

At the Onen’tó:kon Healing Lodge, we strive to make access to our treatment programs as straightforward as possible. Please refer to our intake schedule and download the application form (below) and let us know which session you would like to attend. You must fill out this form completely, however, once we receive it, there will be other information we require. This form can be completed on your PC or on a tablet. Once we receive the form we will contact you using the information you provide.

Download our In-Take Schedule

Download the Onen'to:kon Healing Lodge Application Kit

At the Onentokon Healing Lodge, we strive to make access to our treatment programs as straightforward as possible. However, the The ON LINE form is not available on mobile devices.  Please download the the application kit. We have made the Application Kit fillable, so you may complete it out on your computer, or, print it and fill it out by hand. 

You may return the completed form to us in one of several ways:

  1. Print out the form, fill it in by hand and return it to us by fax or mail  as using the information below.
  2. Fill out the PDF on your computer, and return it to us by email as show below.
  3. Fill out the PDF on your computer, print it and return it to us by fax or mail  as using the information below.

Please refer to the In-Take Schedule below when filling out the Application Kit.

In-House Intake Schedule 2022

Application Deadline

Intake Day

Completion Date

May 2 to 6, 2022                    Admin. Week / Program Review

April 22, 2022

May 9, 2022

June 16, 2022 (6 weeks)

June 20 to 24, 2022               Admin. Week/Program Review 

June 10, 2022

June 27, 2022

August 4, 2022 (6 weeks)

August 8 to 19, 2022           (2 weeks)  Admin./Program Review

August 4, 2022

August 22, 2022

Sept. 29, 2022 (6 weeks)

October 3 to 7, 2022            Admin. Week/Program Review

September 23, 2022

October 10, 2022

Nov. 10, 2022 (5 weeks)

No Admin. Week/Program Review

October 28, 2022

November 14, 2022

Dec. 15, 2022 (5 weeks)

In-House Intake Schedule 2023

Application Deadline

Intake Day

Completion Date

January 2 to 6, 2023             Admin. Week/Program Review

December 3, 2022

January 9, 2023

Feb. 16, 2023 (6 weeks)

February 20 to 24, 2023      Admin. Week/Program Review

February 10, 2023

February 27, 2023

April 6, 2023 (6 weeks)

April 10 to 14, 2023              Admin. Week/Program Review

March 31, 2023

April 17, 2023

May 25, 2023 (6 weeks)

Onen'to:kon Healing Lodge On-line Application Form

Application for Submission
  • Step 1
  • Step 2
  • Step 3
  • Step 4

Application for Submission

For Intake Decisions, files will be considered complete ONLY once the Application & Telephone Interview are complete. All Applications MUST be completed including all medical test results (2) TWO WEEKS before the assessment telephone interview. Please fill out the form as completely as possible



Pre-treatment telephone interview and mandatory contact information

A Photocopy of your beneficiary status and health card are required. If a copy of the Status/Beneficiary Cards are unavailable, a Letter of Affiliation from your respective community is required.


Mandatory information

Identification of referral worker



Step 2 - Your current situation




Step 3 - Legal Matters

Previous convictions and legal documents are required.


Offence #1


Offence #2


Offence #3


Offence #4


If applicable, provide a photocopy of the Parole Certificate/Court Mandate.

Step 4 - Alcohol and Drug Use

List substances that you are currently using (select all that apply):