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R60 Peer Support

We're glad you have connected with us and are interested in starting your recovery journey. Below is a form that will help us make sure you get partnered with someone to help you during your recovery program.  
 

Click the button below to start.

Start

Question 1 of 8

First & Last Name

Question 2 of 8

Email Address

Question 3 of 8

Phone Number

Question 4 of 8

Current Age

Question 5 of 8

Which program would you like to sign up for? 

A

Program 1: The Cure & 5 Steps to freedom

B

Program 2: 7 Pillars

C

Program 3: Genesis Process

Question 6 of 8

What days/ times are you available? 

(Select all that apply)
A

Monday Mornings

B

Monday Afternoons

C

Monday Evenings

D

Tuesday Mornings

E

Tuesday Afternoons

F

Tuesday Evenings

G

Wednesday Mornings

H

Wednesday Afternoons

I

Wednesday Evenings

J

Thursday Mornings

K

Thursday Afternoons

L

Thursday Evenings

M

Friday Mornings

N

Friday Afternoons

O

Friday Evenings

P

Saturday Mornings

Q

Saturday Afternoons

R

Saturday Evenings

Question 7 of 8

What hobbies or interests do you have?

Question 8 of 8

Do you have any questions for us regarding our programs?

Confirm and Submit