Recovery Renaissance

Where Recovery Meets Creativity

Step 1of 3• Personal & Substance

Personal & Substance

Health & Employment

Legal & Program

Personal & Substance History

Full Name (First, Middle, and Last) *

Phone Number *

Current Address / Living Arrangement

Date of Birth

Marital Status

Do you have children?

Yes

Are you a Veteran?

Yes

Are you currently using drugs and/or alcohol?

Yes

Which drugs / alcohol do you abuse? Please explain.

Have you ever been in drug / alcohol treatment?

Yes

Have you ever lived in a sober living environment?

Yes

Questions? Contact us:

(423) 529-1955P.O. Box 1043, Elizabethton, TN 37644