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For those looking to hire a Recovery Coach
If you are paying for this service for someone else, please make sure the individual is filling this form out. Thank you!
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Email
*
Your email
What is your name?
*
Your answer
Are you over 18 years old?
*
Yes
No
Required
If you're under 18, how old are you?
*
Your answer
What is your drug of choice (pot and alcohol are included)?
*
Your answer
When was the last time you used/drank?
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Your answer
What brings you to looking into having a Recovery Coach?
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Your answer
Are you open to attending 12-step meetings?
*
Yes
No
Maybe, if I knew more about them
Required
This is a paid service. Are you able and willing to find the funds to pay for being coached?
*
Yes
No
I will find a way.
Required
Is there anything else you'd like to share about your situation as it pertains to drugs and wanting to seek recovery?
*
Your answer
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