Recovery of Self Counseling Application for Three-Day Intensive

Recovery of Self Counseling
Application for Intensive

Welcome to Recovery of Self Counseling. In order to be considered for an Intensive, please answer all the questions below and, when finished, click on the "Submit" button. You will be contacted soon regarding your application.

Each person must fill out his/her own application. DO NOT fill out an application for your spouse/partner. By completing this application you are attesting that you are the person named below.

Couple's Intensive
Individual Addict
Individual Partner
Individual Trauma Care
Yes
No
Yes
No
Not Yet in Recovery
Currently in Recovery
Not Applicable
Not Yet in Recovery
Currently in Recovery
Not Applicable
Not Yet in Recovery
Currently in Recovery
Not Applicable
Not Yet in Recovery
Currently in Recovery
Not Applicable
Not Yet in Recovery
Currently in Recovery
Not Applicable
Not Yet in Recovery
Currently in Recovery
Not Applicable
Not Yet in Recovery
Currently in Recovery
Not Applicable
Not Yet in Recovery
Currently in Recovery
Not Applicable
Not Yet in Recovery
Currently in Recovery
Not Applicable
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
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