FARR-Certified Recovery Residence

Placement Inquiry

Complete the sections below so we can understand the prospective resident's situation, referral information, readiness, and move-in needs.

Structure Home Living is a structured sober living environment and is not a licensed treatment program.

1. Info

2. Referral

3. Situation

4. Recovery

5. Financial

6. Considerations

7. Submit

Step 1: Basic Information

Full Name * Phone Number * Email Address * Date of Birth * Gender *

Step 2: Referral Information

Are you a referral partner or self-referral? Organization Name Referral Contact Name Referral Contact Phone Referral Contact Email

Step 3: Current Situation

Current Living Situation * Current City/State * Preferred Move-In Timeline *

Step 4: Recovery & Readiness

Are you currently in recovery? * Are you willing to live in a structured sober living environment? * Are you willing to follow house rules, including curfew, testing, and accountability? *

Step 5: Employment & Financial

Are you currently employed? * If not employed, are you actively seeking work? Do you have income or financial support? *

Step 6: Additional Considerations

Any medical or mental health conditions we should be aware of? Any current medications? Any legal requirements, probation, court obligations, or pending cases?

Step 7: Final Information

Is there anything else you would like us to know?

I understand that Structure Home Living is a structured sober living environment and not a licensed treatment program. *

Structure Home Living • 954-667-9040 • contactus@structurehomeliving.com