Intake Form Please fill out the fields below to start joining the David's House community. Name* First Last Date of Birth* Date Format: MM slash DD slash YYYY Phone Number*Email* Emergency Contact* First Last Relationship*Emergency Contact Phone Number*Emergency Contact Email* Drug & Alcohol InformationHow long have you been sober? Do you know the date?*Drug(s) of choice*Have you ever lived in a Sober Living Home?*YesNoIf yes, which one?*Legal InformationAre you currently on probation?*YesNoAre you currently on parole?*YesNoWhat is your judicial district?Do you have a voucher (state payment)?*YesNoConsent* I agree to this website and David's House privacy policy.CommentsThis field is for validation purposes and should be left unchanged.
