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Client Pre-Screening Form

Welcome to House 88 Living

We offer a safe, supportive sober living environment for those ready to move forward and maintain a sober lifestyle. We’re intentional about who we accept to ensure the best environment for everyone in the home.
Please complete the form below to be considered.

PERSONAL INFORMATION

First Name *

Last Name *

Date of birth *

Phone *

Email *

Gender *

Male

Female

Transgender

Binary

Race/Ethnicity

Client Occupation *

Income Provider Information *

Reason for leaving? *

If abuse, we will call stating we are LaCenas Homecare Agency offering you a job. If this is something you would like, please select.

Please call as another entity. *

No

Yes

Has client been homeless within the last 6 months? *

Yes

No

Is the client at risk of homelessness? *

Yes

No

Does the client have a child/children? *

Yes

No

If yes, how many and ages?

Bedroom type the client is interested in? *

Private

Shared

No Preference

Does client have transportation? *

Yes

No

Does the client smoke? *

Yes

No

Where are you currently in your recovery journey? *

I’m currently in treatment and planning next steps

I’ve recently completed treatment

I’m in early recovery and working on staying sober

I’ve been sober for a period of time and want to maintain it

I’m in recovery but still figuring things out

I’m not currently sober but looking to make a change

Prefer to discuss this privately

Would you like to share anything else about your recovery journey?

Does client have criminal record? If yes, please explain.

Is the client on probation or parole? *

Yes

No

If yes, please provide name and number of officer.

Does client have a pending court case? *

Yes

No

Are you a public offender? *

Yes

No

Does the client take any prescribed medications? *

Yes

No

Mental illness? *

Yes

No

If yes, please explain.

Thank you for applying to House 88 Living.

We appreciate your interest in a supportive, structured living environment.
All applications are reviewed to ensure the best fit for our home.

Please call 810-880-4015 once form has been completed.

We hope to hear from you soon.

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Phone

(810) 880-4015

Email

[email protected]

House

We respond to inquiries within 24 hours.

A structured, elevated living environment for individuals committed to long-term sobriety and personal growth.

COMPANY

Contact

(810) 880-4015