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APPLICATION FOR RESIDENCY

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Are you currently at a treatment facility?
Have you stayed in a recovery house in the past?
Do you have current or pending legal charges?
Are you on probation or parole?
Do you have an active warrant?
Are you a sex offender?
Have you been convicted of a violent crime?
Are you employed?
Do you have the funds available for rent?
Do you have a spouse or family willing to help pay?
Do you collect SSI or disability?
Will you be applying for a grant?
Have you participated in 12-step recovery before?
Do you have a sponsor?
Are you currently taking any medications?
Do you need a mental health referral?

By applying for residency with Broadway Recovery Services, I understand that if I am prescribed mental health medications for a diagnosed mental health condition, I am required to remain compliant with those medications unless recommended to cease or change medications by my prescriber. If a life threatening or health problem arises due to current medication regimen, you must seek medical attention immediately.

Thanks for submitting!