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Get Started
About Us
- Gallery
- Testimonials
FAQs
Make A Payment
Contact Us

Tell us more about you

We would love to begin the process of having you, or someone you know, join us at Sunrise Sober Living. The first step is to fill out this form with the applicant’s basic information, and we will be back in touch shortly with next steps.

First Name(Required)

Last Name(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Email(Required)

Mobile Number(Required)

Preferred Contact Method

How did you hear about us?

Check which current forms of identification you possess.

Driver's License (active/inactive)

Social Security Card

Birth Certificate

None

Where are you currently being treated? (if this does not apply to you then put no or n/a)

Who is your Case Manager or Responsible Party? (Name and Phone)

When is your discharge date scheduled?

MM slash DD slash YYYY

When and where have you been treated for substance abuse in the past?

Where will you be moving from?

How long has your longest length of sobriety been?

List all medications you are currently taking (including Suboxone or Vivitrol):

Are you choosing to seek residence at our halfway house/transitional living facility on your own, or is sober living residency required of you?

I am choosing it for myself.

Someone is choosing it for me.

Both

Have you ever lived in a sober living or halfway house environment?

Primary substance of choice:

Date of last use:

MM slash DD slash YYYY

List other substances used with any regularity:

Will you be attending outpatient rehab (IOP)?

How many times have you attended inpatient rehab?

How many times have you attended outpatient rehab?

Have you participated in a 12-step program?

Yes

Please list any mental, emotional, or physical conditions. (If none then put n/a):

Please list any previous (last three years) or pending legal charges, court dates, or outstanding warrants. (If none then put n/a):

Are you currently on probation (county corrections or community corrections)?

Yes

If so, please explain (if you answered no to the previous question then put n/a):

Please list any previous (last three years) or pending legal charges, court dates, or outstanding warrants. (If none then put n/a):

Are you employed?

Yes

If so, please describe (shift, company, location)(if you answered no to the previous question then put n/a):

Do you have a vehicle?

Yes

Please describe your current situation: Why are you seeking a transitional living environment?

What is your expected length of stay at our sober living home?

Who will be covering the costs of your lease at Sunrise Sober Living, you or someone else?

I will be responsible for covering the costs

Someone else will be responsible for covering the costs

I understand that I must be fully detoxed and be able to pass a weekly drug screen at Sunrise Sober Living. I also agree to meet the financial obligations associated with my residency at Sunrise Sober Living.

Sunrise Sober Living

We want to be a part of your journey of growing, preparing and inspiring to help you create a new story of hope, healing, and happiness.

Murfreesboro, TN
brett@sunrisesoberhomes.com
615-973-4914

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Sunrise Sober Living

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