Heart Rock recovery center could be the new beginning you seek

You’ve explored our programming, you’ve visited the premises via our virtual tour and you’ve confirmed you qualify for the long-term sober living program at Heart Rock recovery center. The only thing left to do, is apply.

Apply Online

Fill out our secure, confidential online form by clicking the button below. 

Fill Out Online Form

Apply Via Email

Fill out the PDF form linked below and email it to contact@heartrockrecovery.org

Form needs to be completed in its entirety.

Emergency contact

Substance Use Information

Medical Information

HIV

HEP

TB

STD's

List all medications, include over the counter and prescription.

3mg/day
Inhaler, injection, oral
3mg/day
Inhaler, injection, oral
3mg/day
Inhaler, injection, oral
3mg/day
Inhaler, injection, oral
3mg/day
Inhaler, injection, oral
3mg/day
Inhaler, injection, oral
3mg/day
Inhaler, injection, oral
3mg/day
Inhaler, injection, oral

Domestic Violence

Legal History

Criminal History

Income/Employment History

Work experience: Most recent first, going back 3 years

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