Recovery Home Vetting Request — Waves To Wellness

Apply to have a recovery home vetted

This form should be filled out by someone affiliated with the recovery home only. Someone from Waves To Wellness will get back to you shortly.

What house/address?

Organization affiliated with the house?

Name

First Name

Last Name

Cell Phone

(###)

###

####

Role with the organization?

How many homes are affiliated with your organization?

Are you a 12 step recovery based program?

Do you provide or require IOP/PHP?

Do you provide Medication-Assisted Treatment/housing?

Do you provide on-site housing managers?

What other programs do you offer residents?

Any other information you would like to tell us:

How did you hear about us?

Referral source and best contact information: