Application Form for Drew's Sober Living
Please fill out the form below to apply for Drew's Sober Living.
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
What is your birth date?
-
Month
-
Day
Year
Date
What location are you looking to move into?
*
Chittim House - North San Antonio
Evergreen House - Central San Antonio
Chapel house - New Braunfels
I am open to any!
What date do you need to move in?
-
Month
-
Day
Year
Date
Tell us about yourself and why you are seeking sober living.
*
Have you lived in a sober living before?
*
Yes
No
Are you currently taking any medications?
*
Yes
No
Can you pass a drug and alcohol test?
*
Yes
No
Maybe
I am prescribed medication that will cause me to fail.
Are you currently employed?
*
Yes
No
Im working on it
I am unable to work
Do you have a valid driver's license?
*
Yes
No
Im working on it
I am unable to drive
Do you own a vehicle?
*
Yes
No
Im working on it
I am unable to drive
Have you been to an inpatient treatment for substance abuse or mental health before. If so, when and where was the last time you went in treatment.
*
When was the last time you used drugs or alcohol?
*
Are you currently participating in a recovery program?
*
Yes
No
Do you have a 12 step sponsor?
*
Yes
No
Other
What are your recovery goals?
*
Do you have a source of income to pay your program fees?
*
Yes
No
Not Yet
Are you able to make the initial deposit and pay your program fees on time?
*
Yes
No
Not Yet
Do you have any medical conditions or disabilities we should be aware of?
Do you have a primary care doctor?
*
Yes
No
Do you have a therapist?
*
Yes
No
Do you have health insurance?
*
Yes
No
Do you have any pending legal matters?
*
Yes
No
Are you on probation or parole?
*
No
Probation
Parole
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Is there anything else we need to know about you, or anything you would like to share with us?
What size shirt do you wear?
*
Small
Medium
Large
XL
2XL
3XL
Other
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