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Peer Recovery Form

Use the form below to apply for Peer Recovery.
Peer Recovery Services Application
Recovery Journey Information: Do You Identify As?
CURRENTLY IN TREATMENT?
Are you currently employed?
I.O.P. is 9:00AM to 12:30PM on Monday thru Thursday and you are able to commit with your schedules?
On Probation/Parole?
Emergency Contact:
Document(s) Upload: Please provide the following:
Are you on medically- assisted treatment?
Upload File
Upload File
Upload File

Thanks for registering. See you there!

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