Welcome to Firm Foundation Recovery.

We're glad you're here. This intake form helps us get to know you before move-in so we can set you up for success. Answer as honestly as you can — everything shared here stays within FFR and is used only to support your program participation.

Click Next to get started.

 

FIRM FOUNDATION RECOVERY — GUEST INTAKE FORM

PERSONAL INFORMATION

First name: Client first name

Middle name:Client middle name

Last name: Client last name

Date of birth:Client birthdate

Social Security Number (last 4 digits only): SSN

Gender:Client gender

Marital status:Client marital status

Are you a veteran?:Client veteran status

CONTACT INFORMATION

Cell phone number:Client phone

Email address:Client email

Current address or where you are coming from:Client Address

EMERGENCY CONTACT

Emergency Contacts and Coordination

 

LEGAL STATUS & SUPERVISION

Legal Information/Probation Information

SUBSTANCE USE & RECOVERY

List All Mind Altering & Life-Controlling Substances Used (Alcohol/Drugs/Other)

 

MEDICAL & MENTAL HEALTH

Health, Medication, and Safety Information

Medical Information

Mental Health Status

EMPLOYMENT & FINANCIAL

EmploymentHistory

HOUSING HISTORY

SoberLivingHistory

SUPPORT SYSTEM & REFERRAL

Recovery, Daily Living, and Support Information

GOALS & COMMITMENT

Why are you seeking sober living at this time?Text field

What does lasting recovery look like for you?Text field

Do you understand that FFR is a structured program, not a rental arrangement?Text field

Do you agree to random drug and alcohol testing?Text field

Do you agree to attend a minimum of 2 AA or NA meetings per week (unless asked to attend a different amount by staff)?Text field

Do you understand that FFR uses a mobile app to track check-ins and movements?Text field

Do you understand you are responsible for household chores as assigned?Text field

Is there anything else we should know before your move-in?Text field

WHAT HAPPENS NEXT

Thank you for completing your intake form. A member of the FFR team will review your information and contact you within 24 hours. If you are approved, you will receive your move-in date, payment instructions, and program documents to sign before arrival.

Questions? Call us at 701-695-5544.