If you are in immediate need of a sober companion please let us know
The information you provide us, is kept strictly confidential.
Your name *
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Your phone number *
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Your email *
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Your address (city / state / zip / country) *
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Your addiction (check all that apply) *
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How long have you been sober? *
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Have you been to rehab? *
Who will be financially responsible for your care? *
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Please provide contact info for financially responsible party *
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Do you have any immediate questions?
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