The Father's House Pre- Admission Application

Full Name *

Email address *

Phone number

Preferred contact method *

Are you currently taking any medications *

Are you disabled or on disability? If yes, please explain *

What life controlling issues are you struggling with that you think we could help you resolve *

What substances are you currently using and how often do you use them? *

Are you willing to commit 12 months of your life to this program? *

Please explain why we should take you into our recovery program. *

Is there anything else that you would like to say regarding your application? *

What date would you like to enter TFH? * +

Signature *

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