Sober Vibes Application

Step 1 of 4 - Contact Info

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Name(Required)

First Last

Date of Birth(Required)

MM slash DD slash YYYY

Sobriety Date(Required)

MM slash DD slash YYYY

Phone(Required)

Email(Required)

Emergency Contact(Required)

First Last

Emergency Contact Phone(Required)

Preferred Method of Contact(Required)

Do you have reliable transportation?(Required)

Are you employed?(Required)

Are you a registered sex offender?(Required)

Are you currently taking any medications? If so, please list them.(Required)

Are you currently attending court for any reason? If so, please list.(Required)

When will you be ready to move in?(Required)

MM slash DD slash YYYY

Drug of Choice(Required)

Do you have the ability to pay the first month's rent and move in fee ($700) upon check in?

Yes

We want to know more about you! Please be as honest as possible in your answers:

Why do you think Sober Vibes is a good fit for you?(Required)

What do you struggle with most in sobriety?(Required)

What would you say is your biggest trigger?(Required)

Have you ever been to treatment? If so, where was it and did you successfully complete it?(Required)

How did you hear about us?(Required)

What are three things you love about yourself?(Required)

Are you willing to commit to a year?(Required)

What is your number one fear or apprehension when it comes to living at Sober Vibes?(Required)

What are you most excited about in your journey to recovery?(Required)

Do you have a good support system?(Required)

What are three short term goals you want to accomplish in sobriety?(Required)

What is one long term goal you want to accomplish in sobriety?(Required)

Tell us about yourself! What was the most recent event that made you want to turn your life around?(Required)

CAPTCHA