Phase One Application Name * First Name Last Name Email * Phone Number * (###) ### #### Date of Birth * Current Sobriety Date and Substance of Choice * Any Medical or Mental Health Disorders? * Are you on medications for Medical or Mental Health Disorders? * Yes No Do you have any pending issues or court dates? * Yes No If so, for what charge(s) and when is your court date? * Previous Convictions (and dates of conviction(s)) * Previous Treatment Program Attendance * When and where have you gone to treatment? Have you been to any sober living's in the last 12 months? * Yes No If so, which ones and why did you leave? * Why are you seeking sober living now? * Are you currently employed? * If so, where do you work and what shift are you on? If no, how do you plan on paying for your stay at FHSL? How long are you wishing to stay at FHSL, if accepted? * What does Recovery mean to you? * How do you handle conflict with peers and authority figures? * Give an example of a recent conflict you have experienced with both and how you went about resolving it. How do you handle cravings and triggers? * In your opinion, what was the cause of your most recent relapse? * Name 3 things you learned at any level of recent substance abuse treatment (rehab): * What are you going to do differently this time that you did not do last time? * Thank you for your interest in our Program! Please email WilliamDaugherty@FindingHopeSoberLivings.com or text/call 423-443-8083 with any admissions’ questions.
