Contact Wizard – Addiction Treatment Rehab Intake Lead Form

Purpose-Built Addiction Treatment Lead Intake for WordPress

M Media Addiction Treatment Contact Wizard is a professional multi-step intake plugin for addiction treatment centers and rehab facilities, built to collect the detailed clinical and financial information you need before an admissions call – without requiring a CRM, intake form builder, or third-party referral service. The wizard walks visitors through structured steps covering substance type, usage history, insurance coverage, and urgency level. Every submission is stored in your WordPress dashboard and delivered to your inbox. No monthly fees. No lead-sharing. Your leads stay yours.

Why M Media Addiction Treatment Contact Wizard Exists

Generic contact forms collect a name and email. That is not enough to have a productive admissions call with someone seeking treatment. You need to know what substances are involved, whether they have insurance, and how urgent the situation is. M Media Addiction Treatment Contact Wizard solves this by design. It gives every visitor a guided, confidential experience while giving your admissions team a complete intake record before they ever pick up the phone.

M Media Addiction Treatment & Rehab Intake Wizard replaces the basic contact form with a guided, HIPAA-conscious intake wizard designed for addiction treatment and rehab centers.

Why a wizard?

Standard forms miss critical info. This wizard qualifies the lead and collects all required patient and insurance details up front—so your admissions team can focus on serious inquiries, not incomplete forms.

What it does:

  • 5-step guided intake — Treatment Needs → Patient Details → Insurance Info → Consent & Agreements → Confirmation
  • Insurance card upload — patients can securely upload photos of their insurance card (JPG, PNG, PDF, HEIC). Files are stored privately in your WordPress media library.
  • Consent & HIPAA agreements — collects digital consent and agreement to privacy policies.
  • HTML email notifications — admissions staff receive a summary email with all submitted data and insurance card thumbnails (no PHI in subject line).
  • Lead management — every submission is saved as a custom post type (atrcw_lead) with all intake data and uploads visible in the admin.
  • Fully customizable — edit intro text, success message, notification email, and toggle/relabel any question from the Settings panel.
  • SMTP support — configure SMTP delivery or fall back to wp_mail().
  • Spam protection — honeypot field + minimum submission time check.

Shortcodes:

[addictiontreatmentrehabintake_wizard] or [mmedia_addictiontreatmentrehabintake_wizard]

Place either shortcode on any page or post.

Installation

1. Upload the mmedia-contact-wizard-addiction-treatment-rehab-intake folder to /wp-content/plugins/.

2. Activate the plugin through Plugins → Installed Plugins.

3. Go to Addiction Intake Wizard → Settings to configure your notification email and customize the wizard.

4. Add [addictiontreatmentrehabintake_wizard] to any page.

Requirements

  • WordPress 5.8+
  • Tested up to WordPress 6.9
  • PHP 7.4+

Shortcodes

  • [addictiontreatmentrehabintake_wizard]
  • [mmedia_addictiontreatmentrehabintake_wizard]

$29.99

Perpetual License

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  • • Buy once, own forever
  • • Works offline
  • • Optional updates
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Simple Licensing. No Games.

We don't believe in dark patterns, forced subscriptions, or holding your data hostage. M Media software products use clear, upfront licensing with no hidden traps.

You buy the software. You run it. You control your systems.

Licenses are designed to work offline, survive reinstalls, and respect long-term use. Updates are optional, not mandatory. Your tools don't suddenly stop working because a payment failed or a server somewhere changed hands.

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Upgrade when you want to, not when we force you
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No Bloat. No Spyware. No Nonsense.

Modern software has become surveillance dressed as convenience. Every click tracked, every behavior analyzed, every action monetized. M Media software doesn't play that game.

Our apps don't phone home, don't collect telemetry, and don't require accounts for features that should work offline. No analytics dashboards measuring your "engagement." No A/B tests optimizing how long you stay trapped in the interface.

We build tools, not attention traps.

The code does what it says on the tin — nothing more, nothing less. No hidden services running in the background. No dependencies on third-party APIs that might disappear tomorrow. No frameworks that require 500MB of node_modules to display a button.

Your data stays on your device
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