Intake form

Name *

Email address *

What is your preferred method of communication?

What type of recovery support are you seeking?

Please select at least one option.

Peer Support

Community Integration

Tenant Rights Advocacy

Do you have any previous experience with recovery housing?

What is your current housing situation?

Please select at least one option.

Stable

Transitional

Homeless

Seeking Housing

What is your age range?

Please specify any special requirements or needs you may have.

Which service or services are you interested in?

Please select at least one option.

Peer-supported recovery housing

Tenant advocacy

Community integration initiatives

Trauma-informed care in recovery housing

Social model recovery

Housing security

Additional questions or comments

Pacific Horizons of California