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Apply to Thrive
First name
*
Last name
*
Email
*
Phone
*
Date of birth
*
Month
Month
Day
Year
Sobriety Date
*
What is your goal?
*
Overview of your treatment history
*
Relapse history
*
What does your support system look like?
What are your triggers?
*
Do you have any legal issues? If so pleas explain
*
Have you lived in sober living before? If so, what was it like?
*
Is Jesus your higher power?
*
Yes
No
Are you willing to be on a wait list?
*
Yes
No
Submit
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