FREEDOM THROUGH ACTION​

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Call Us: (888) 527-1508

Pre-Admission Form

Live Free Recovery and Sober Living

Call Us: (888) 527-1508

Live Free Recovery and Sober Living Pre-Admission Form

Please fill out the form below and one of our staff members will contact you shortly.

Application

"*" indicates required fields

Name*
Date of Birth*
Mailing Address*
Mental Health
Do You Have A Mental Health Diagnosis?*
Have You Ever Attempted Suicide?*
Do you have a history of self-injurious behavior?*
Have You Ever Been Convicted Of Arson?*
Have You Ever Been Convicted Of A Sex Crime?*
Live Free asks that you be willing to commit to staying here for a minimum of 3 months and also be willing to fully participate in our program:
Is This Something You Are Willing To Commit To?*
What Date Are You Looking To Be Admitted?*
I agree to Privacy Policy*

Take the First Step Towards a Brighter Tomorrow

At Live Free Recovery, we’re committed to walking alongside you on every step of your journey. Our compassionate team is here to provide the guidance and support you need to overcome addiction and reclaim your life. Don’t wait—reach out today to speak with someone who truly understands your struggles and can help you take that important first step toward healing and a fresh start.

Your path to recovery starts here.

(888) 527-1508
(888) 527-1508
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