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]