Online Application - Sober Living in Austin & Houston, TX
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Program Application

This application is for internal uses only. The questions are designed to assist Eudaimonia Recovery Homes in utilizing our resources to assist you in your recovery through accountability and aiding you in any obstacles you may need to overcome.

Demographic Information:

Full Name:

Date of Birth:

Social Security Number:

Home Address:
City:
State:
Zip:

Phone Number:

Email:

Martial Status : SingleMarriedDivorced

Emergency Contact

Full Name:
Phone Number:
Email Address:
Relationship:

Legal

Are you currently on probation or have pending charges? (Please provide detailed information):

Have you ever been convicted of any felonies?:

Treatment History

Sobriety Date:
Are you discharging from a substance abuse facility:YesNo
If Yes: Treatment Center:

Counselor Name:
Counselor Email:
Counselor Phone Number:

Discharge Date:
Current Medications:

Aftercare

Will you be bringing a vehicle?
YesNo
Are you currently employed, and plan to remain with your employer during our program?:
YesNo
Are you currently enrolled in school, and plan on continuing as a full-time student?:
YesNo
Will you be attending an Intensive Outpatient Program (IOP)?:
YesNo
If Yes:
If no, would you like information regarding our IOP program?:
YesNo

Location

Which city are you interested in?:
Austin, TXHouston, TXColorado Springs, COChicago, IL
Is there a particular home you are wanting to live in?:
Have you lived in a sober living home before?: YesNo
How did you hear about Eudaimonia Recovery Homes?:

Financials

Yearly Gross Income:
Yearly Expenses:
Are you wanting to : Private PayUtilize Insurance

If Utilizing Insurance:
Insurance Company:
Company Phone Number:
Member ID Number:
Group Number:
Type of Plan:

Signature:

Rooms Available – Apply Now!
Eudaimonia Homes