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Apply for a family member (12 weeks Recovery Coaching With Amber)

Tell us a a bit about your loved one's situation.

It should take between 10-15 minutes to answer these questions.  Afterward, we'll review your application, and get back to YOU within one bussiness day. 

Start

Question 1 of 12

What's your loved one's name, age, and relation to you?

Question 2 of 12

We don't need an entire history but if you could tell us a little about the problem, that would be helpful. 

Question 3 of 12

Has your loved one tried other things in the past?  (counseling, treatment, 12-step meetings, other..) Was it helpful? 

Question 4 of 12

Have you talked to your loved one about starting recovery coaching?  (What's happening that letting you know that they're ready for this?) 

Question 5 of 12

What outcome are you hoping for?

Question 6 of 12

Why do you think Amber is the right person to help to help your loved one? 

Question 7 of 12

What will happen if your loved one doesn't address this problem?

Question 8 of 12

Are you wanting them to start this month or next? 

Question 9 of 12

Amber typically sees clients on Tuesdays and Wednesdays during regular work hours.  Is this going to work for your loved one's schedule?

Question 10 of 12

Anything else we should know? 

Question 11 of 12

We're definitely going to need your help too!  Are you a member of our Family Recovery Membership? If not, are you willing to become a member and participate while your loved one is coming to coaching? 

Question 12 of 12

Name, phone number, and email? 

(*please put YOUR info here, you'll have the oppertunity to give us their into in the next question)

Confirm and Submit