• Sober Living Application

    Fill the form below accurately.
  • Before you begin:

    Be certain that you have read and agreed to our Sober Living Agreement Click on the link to review this now. This is a MUST !!!

    You will need the following items

    • A list of all
      • medications, names, milligrams & frequency
      • Doctors names and contacts
      • current treatment information
      • Probation information including phone #'s
  • Provide as much information as possible. Incomplete applications will not be considered. Let your efforts in this reflect your desire for recovery.

     

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  • Addiction History

  • 0/0
  • 0/0

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    Pick a Date

  • Treatment and Mental Health History

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    Pick a Date
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  • * Please be certain to have a release of information filed so that I may inquire of your treatment team.

  • Mental Health

  • Medical Conditions

  • Browse Files
    Cancel of
  • Relationships


  • Level of Education


  • Legal Information


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  • Identification and Transportation

  • Employment

  • References

     Please list two (2) references that are familiar with your life and current situation.

  • Reference 1

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  • Reference 2

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  • Clear
  • Should be Empty:
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