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Recovery Application
For Female Recovery Only
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Email
*
Your email
Name
*
Your answer
Address
*
Your answer
phone
Your answer
Are you on Probation?
*
Yes
No
Maybe
Are you on Parole?
*
Yes
No
Maybe
How interested in Recovery are you? Give Details
*
Your answer
What makes you think you would want to live sober for the rest of your life?
*
Your answer
Who supports you in your recovery?
*
Your answer
When do you want to start your recovery?
*
Your answer
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