Initial Orientation Request Form

You may schedule an orientation appointment in two ways. 

  1. Either call the ADI office at (408) 879-7581 Monday - Thursday between the hours of 9:00AM - 5:00PM or Friday between 9:00AM - 4:30PM
  2. Or fill out the form below and submit it to ADI
Select the program you are required to attend. *
 


6 Week Wet Reckless Program 12 hours
3 Month First Offender Program
9 Month Enhanced First Offender Program
18 Month Multiple Offender Program
Outpatient Drug and Alcohol Counseling & Treatment
Drug and Alcohol Assessments
Not Sure

 
First Name:   *
Last Name:   *
Street Address:  
State:  
ZIP Code:   *
Email:   *
Phone:   *
County of your arrest:   *
Date you must enroll by:  
Comments:  
*Required fields