Recovery Coaching Inquiry Form
Recovery coaching is a non-clinical, strengths-based support service designed to help individuals in early or ongoing recovery from substance use disorders and other addictive behaviors. It is not a form of treatment, so recovery coaches do not diagnose, treat, or address mental health conditions. A recovery coach acts as a trained peer mentor or accountability partner who supports clients in building and strengthening skills, resources, and motivation for recovery. Recovery coaching is about empowering individuals to take ownership of their recovery journey, providing the guidance, resources, and accountability needed to sustain long-term sobriety and personal growth.
Full Name
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First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Please provide details about why you are seeking a recovery coach.
*
Additional Comments or Relevant Information
Thank you for your interest! Our recovery coach will reach out to you soon!
Submit Referral
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