If you answered yes to any of the above legal questions, please explain:
Please describe any medical issues marked "yes":
Medications (List all current medications prescribed, non-prescribed, or any over the counter):
List all mental health hospitalizations in the past 3 years:
What are your substance(s) of choice?
Describe your current living situation:
Explain reasons for wanting to live in The Evolution House:
Describe your current recovery goals:
Describe what you have done for your recovery that has been successful:
Describe what you have done for your recovery that has NOT been successful:
What are the best ways The Evolution House can support you in establishing long-term recovery?