ADMISSIONS & INQUIRIES

Housing Application

An initial housing inquiry for adult men seeking a structured, substance-free home.

Complete and submit this initial inquiry online, or print / save a PDF. Required fields are marked. Submission does not guarantee admission, reserve a room, enroll you in coaching, or authorize payment. Do not include medical records, Social Security numbers, or payment details.

Contact & housing needs

Full name (required)Preferred name (optional)Phone (required)Email (required)Preferred contact methodDesired move-in date

Room preference (required) I am an adult man seeking substance-free recovery housing. (required)What are you looking for in a shared living environment? (optional)Practical questions or accessibility needs you would like to discuss (optional)

Do not enter Social Security numbers, payment information, diagnoses, treatment records, or detailed substance-use history here.

Acknowledgments

I understand this is private-pay, nonclinical housing, and optional coaching costs are separate. (required) I understand that room availability, house requirements, applicable regulations, and final approval determine admission. (required) I understand that a final resident agreement and written fee policies must be reviewed separately. (required)

Applicant name / signature on printed copyDate

I consent to sending all information entered in this form by email to admin@sosrecovery.com for review and follow-up. Email is not a secure medical-record channel. I have read the privacy description. (required)

Checking online submission availability…

For questions or a different way to return this form, call 272-207-8936. Admission is not guaranteed. An application does not reserve a room.

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