WOMENS RECOVERY APPLICATION

Women's Adddiction Recovery Program Application

To be eligible for the addiction recovery program at Harvest House Atlantic, you must:

  • Be 21 years or older, and suffer from life controlling addictions such as: alcohol or drugs among others.
  • Understand that we are not a detox facility; therefore, clients may be required to complete a certified detoxification program prior to entry.
  • Complete a drug screening upon entry into the program.
  • Complete an interview with the Recovery Program Manager.
  • Be committed to receiving long term care.
  • Be open to Faith in Christ principles that aid in recovery.
  • Be cognitively and physically able to participate in programming.

Provide full and complete answers to every question. If a question does not apply to you answer "N/A". Incomplete or misleading information will influence your application and/or stay in the program. If you require assistance in completing the form please call our office at 506-855-0626 between the hours of 10am - 3pm.

Please provide either your phone number and/or your email address.

Do you children?

Do you have a visitation agreement?

Do they currently live with you?

Are you currently taking prescribed medications?

Are you currently involved in any pending court cases?

Success! Your message has been sent to us.
Error! There was an error sending your message.