Who are you reaching out for (son/daughter, age), and what challenges are they currently struggling with? *

What kind of help are you hoping to find at this stage? *

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Has your child been in any form of treatment, sober living, or recovery coaching before? *

Yes

No

On a scale of 1–10, how willing is your child to accept support and structure at this time? *

Professional sober companions cost on average $1000-$2000 per day (private-pay) depending on the level of care. If this is a good fit, are you financially prepared to move forward? *

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Full Name

Email *

Phone *

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