MOMENTUM RECOVERY
RESIDENT ADMISSIONS PACKET Building Momentum Physically, Emotionally & Spiritually
This packet is designed to identify applicants who are committed to recovery, accountability, wellness, and personal growth. Momentum Recovery is more than sober living—it is a community focused on building a meaningful life.
1. Applicant Information
Full Name Client first name
Last Name Client last name
Date of Birth Client birthdate
Phone Client Number
Email Text field
Current Address Text field
Emergency Contact Text field
Referral Source Text field
Move-in Date Requested Text field
2. Recovery Assessment
Primary substance(s)Text field
Sobriety date Text field
Length of sobriety Text field
Describe your recovery journey
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Treatment history
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Criminal Record
Criminal History
Please list all Medications
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Are you currently on MAT? If yes what and how much?
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Meetings attended each week
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Sponsor and step work
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Biggest relapse triggers
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What keeps you sober today?
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3. Wellness & FlexABLE Assessment
Current fitness experience
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Activities you enjoy (walking, hiking, gym, sports, etc.)
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Current exercise routine
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Injuries, pain, or mobility limitations
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Nutrition habits
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Average hours of sleep
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Are you willing to participate in house wellness activities? ■ Yes ■ No
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Are you willing to participate in FlexABLE assisted stretching? ■ Yes ■ No
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Are you willing to participate in FlexABLE personal training? ■ Yes ■ No
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Personal wellness goals
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4. Employment & Independence
Profession / Trade
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Employer & Schedule
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Career goals
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Transportation
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How will rent be paid?
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Financial goals during residency
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5. Community Fit & Momentum Plan
Why Momentum Recovery?
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Top 3 goals (Physical, Emotional, Spiritual, Financial, Career)
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What strengths will you bring to the house?
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How do you handle conflict?
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What does accountability mean to you?
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How will you contribute to a positive recovery community?
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Resident Commitment
I understand Momentum Recovery maintains a structured, substance-free environment. I agree to follow all house policies, submit to random drug and alcohol testing, participate in my recovery, maintain employment or actively seek it, participate in wellness opportunities, respect fellow residents, and uphold honesty, integrity, and accountability.
Applicant Signature Signature________________________________
Date Text field____________________