THE RECOVERY HOUSE
HEALTHY SOBER LIVING FOR WOMEN


5707 Emerson Ave North
Brooklyn Center, Minnesota 55430
Phone: 612 237-3841
Fax: 763 536-1044

website: soberhousingtwincities.com
therecoveryhouse@comcast.net

Application

Application Form
When do you need housing for?:
Full Name and phone *
Last address *
Date of birth: *
Last address *
Person & phone you paid rent to *
Any medical issues?: *
Mental Health Diagnosis: *
Medications currently taken: *
How much clean time do you have?: *
Name of emergency contact person and relationship *
Phone and address of emergency contact: *
Name and phone of employer: *
Drug/drugs of choice *
Will you bring a vehicle with you? If so please fill out vehicle form: *
In case of emergency, whom do we contact? Name and phone *

Please email by pressing submit, fax or mail application and we will contact you.  You may also call for availability.  Thank you for submitting an application.   There will be additional forms to fill out when you are admitted to the Recovery House.
If you are bringing a vehicle with you, you will need to fill out a form at move in.  Please bring with you: a copy of your drivers license, up to date insurence and up to date tabs.