615-823-0781

Please fill out the application

Application

Gender

ARE YOU AN ALCOHOLIC AND/OR A DRUG ADDICT?

PLEASE CHECK ALL OF THE FOLLOWING FORMS OF ID WHICH YOU HAVE IN YOUR POSSESSION:

ARE YOU CURRENTLY IN TREATMENT?

What Type of Treatment?

ARE BOTH YOUR PARENTS LIVING?

ARE THEY STILL MARRIED?

HAVE YOU BEEN DIAGNOSED WITH ANY PSYCHOLOGICAL DISORDERS OTHER THAN ALCOHOL AND DRUG DEPENDENCY INCLUDING MAJOR DEPRESSION, BI POLAR, SCHIZOPHRENIA, PARANOIA, BORDER LINE PERSONALITY, ETC.?

DO YOU HAVE ANY PHYSICAL HEALTH PROBLEMS INCLUDING HERNIA, HEPATITIS B, HEPATITIS C, HIV VIRUS, BACK PROBLEMS, OR OTHER LIMITATIONS?

ARE YOU CURRENTLY ON ANY MEDICATION?

ARE YOU CURRENTLY RECEIVING SSI OR DISABILITY INCOME?

DO YOU HAVE ANY LEGAL CHARGES PENDING NOW?

ARE YOU CURRENTLY ON PROBATION?

ARE YOU COURT ORDERED TO LIVE IN A HALF WAY HOUSE?

DO YOU HAVE $380 ADMISSION FEE (180 PER WEEK,180 REFUNDABLE DEP.+ 20 MISC. DEP)

DO YOU UNDERSTAND THAT THERE ARE NO REFUNDS IF YOU ARE NONCOMPLIANT?

DO YOU HAVE VERIFIABLE EMPLOYMENT?

IF NOT EMPLOYED OR IF YOU BECOME UNEMPLOYED ARE YOU WILLING TO TAKE A JOB WASHING DISHES?

ARE YOU IN A RELATIONSHIP?

IS IT YOUR SPOUSE?

ARE YOU WILLING TO GO A MINIMUM OF 30 DAYS WITHOUT TALKING TO THIS PERSON?

IF NOT IN A RELATIONSHIP ARE YOU WILLING TO STAY OUT OF A RELATIONSHIP FOR ONE YEAR?

ARE YOU WILLING TO WORK ALL TWELVE STEPS BEFORE LEAVING TURNING POINT ?

ARE YOU WILLING TO FOLLOW ALL OF THE SUGGESTIONS AT TURNING POINT?

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