Connection Call: Background Form
Before we get on our session together, please take the time to thoughtfully complete and submit this form.

Your detailed answers will help us best help you. They will be reviewed thoroughly and will guide us to know the best way to support you at this time.

Elaborate on your situation, the challenges you are facing as a result of someone's addiction, and specifically what you are looking for guidance on.

We look forward to seeing you soon.

Kate & the Tipping Point Recovery Team

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Email *
Your Name *
Town/State you live *
Phone Number *
Name of Your Loved One Struggling *
What is your relationship to them? *
What do you know (or think) they are currently using—drugs, alcohol?  Please specify what and how much, if you know. *
Please describe your reason for reaching out NOW. What is different about now that has helped you feel ready for new support & action? *
Who does your loved one live with? *
Do they drive a car? *
Do they have children? If so, what are their ages and who do they live with? *
How are you hoping we can help?  The options below are the full range of services we offer at this time.
On a scale of 1-10, 10 being the highest, how ready are you to take new action that is suggested to foster recovery for your family? *
I'm not at all ready to change.
Tell me what to do, I'm completely ready to end this chaos!
Our Programs and Interventions are fee-based. If you feel the solution we offer is a fit for you, on a scale of 1-10, how willing are you to invest financially in recovery at this time? *
I'm not willing to invest right now.
If it's the right solution, I am ready.
A copy of your responses will be emailed to the address you provided.
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