Intake

The Sobriety Center Intake
the sobriety center is always happy to assist you, please take your time to describe how we can help you.
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Applicant:
Emergency Contact:
It's been ________ since my last time using:
I would describe my condition as:
My living arrangments are:
help us understand your struggle and what has brought you here.
what has helped you cope in the past.
what will the result be if nothing changes