BHIVE Resident Screening
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Email *
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Date *
Name *
Birthday *
Where are you staying now? *
Phone #: *
How did you hear about us? *
Where are you from?   *
What drugs are you recovering from? *
Recovery Date: *
We have a TRI (3) Fold Approach to recovery, in which we advocate 12 step recovery, introduce you to a Loving God that you may or may not know, along with structured living. Are you willing to participate within this approach and do your best to keep an open mind and a degree of willingness? (make sure you understand this because we are going to talk about GOD ) *
When do you need in? *
Do you have a diagnosis besides chemical dependency or alcoholism?Y: If yes what diagnosis? *
Are you on any meds?: *
If so, please list the medication and why it was prescribed. *
Have you been in recovery before? *
Longest time clean? *
Have you ever been to treatment? *
How many times, if yes to the above question. *
Have you been at the BHIVE before? *
If yes, when? *
What were the circumstances that caused you to leave? *
Married or in a relationship? *
If married or in a relationship, where are they now? *
Children? (Insert number) *
If children, where are they? *
Do you have a car? *
Do you have a job? *
If yes, where? *
When are your paydays? *
Are you on disability or SSI? *
If yes, which one and what for? *
Are you on probation or parole? *
If yes, what for? *
Are you a registered sex offender? *
There is a $75 move in fee due immediately, $75 over the next 2 weeks, & $110 each week thereafter ... do you understand & can you agree to this rent policy? *
Please list an emergency contact and their phone number. *
Please write a brief summary about what you hope to accomplish while here at the hive and how you plan to accomplish those goals. *
What is your favorite kind of cake? *
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