• AHR Sponsor Ticket
  • AHR Sponsorship and Table Purchase
  • Appreciative Inquiry Interviews
  • ARCO Leadership Summit 2019 Agenda
  • ARCO LS 2019 Session Detail Submission
  • ARCO Session Evaluation
  • Atlantic OHH
  • Beta Testing Feedback
  • Burlington OHH
  • C4R Check-In
  • C4R Contact
  • C4R Member Registration
  • clr
  • Communities For Recovery
  • Donate
  • F&V Contract
  • F&V Support Request
  • First Time Visit
  • Focus RWC
  • Focus RWC Activity Check-in
  • Focus RWC First Time Visit
  • Focus RWC Meeting Attendance
  • Focus RWC Member Check-in
  • Focus RWC New Member
  • Focus RWC Volunteer Log
  • Illinois Stigma
  • Internal Survey
  • Kiosk Beyond Brink
  • Kiosk Beyond Brink Form
  • Kiosk Cape Regional
  • Kiosk Cape Regional Form
  • Kiosk Courage Center
  • Kiosk Courage Form
  • Kiosk Dee’s Place
  • Kiosk Dee’s Place Form
  • Kiosk Home Template
  • Kiosk Hope Coalition
  • Kiosk Hope Coalition Form
  • Kiosk Hope Rising
  • Kiosk Hope Rising Form
  • Kiosk Never Alone
  • Kiosk Never Alone Form
  • Kiosk New Way
  • Kiosk New Way Form
  • Kiosk Recovery Beyond
  • Kiosk Recovery Beyond Form
  • Kiosk RioGrande
  • Kiosk RioGrande Form
  • Kiosk Savannah
  • Kiosk Savannah Form
  • Kiosk Set Up Information
  • Kiosk Template Form
  • Kiosk Trilogy
  • Kiosk Trilogy Form
  • Kiosk Turning Point
  • Kiosk Turning Point Form
  • Kiosk Wakeup
  • Kiosk Wakeup Form
  • LRCC
  • LRCC Activity Check-in
  • LRCC First Time Visit
  • LRCC Meeting Attendance
  • LRCC Member Check-in
  • LRCC New Member
  • LRCC Volunteer Log
  • NJ CARS Forms
  • NJ OAG Kiosk Info
  • NJ RISE OHH
  • NJ-CARS Media Consent
  • OHH Activity
  • OHH Kiosk RH
  • OLDOrg Kiosk
  • Onboarding Feedback
  • Org Kiosk Check-In
  • Org Kiosk Contact
  • Org Kiosk New Member
  • Org Name Kiosk
  • PCAC Kiosk
  • Peer Coach Academy Kiosk
  • PIK Consent
  • Prevention TRS
  • Privacy Policy
  • RCCF Form
  • RDP Agreements
  • RDP Feedback
  • RDP LITE – COVID SURVEY
  • RDP Survey
  • Recovery Connection
  • RLS/AHR Sponsorship Leads
  • SCRW Kiosk
  • Serenity House of Flint
  • SHOF Activity Check-in
  • SHOF BARC-10
  • SHOF First Time Visit
  • SHOF HH Study
  • SHOF Meeting Attendance
  • SHOF Member Check-in
  • SHOF New Member
  • SHOF Volunteer
  • Signature
  • Springs Recovery Connection
  • SRC Event/Training Attendance
  • SRC Meeting Attendance
  • SRC Member Check-in
  • SRC Member Registration
  • Sunrise Community for Recovery Wellness Kiosk
  • Tech Onobarding
  • Technical Assistance Feedback
  • Thriving U Kiosk
  • Thriving United Kiosk
  • TU Check-In
  • TU Contact Request
  • TU Participant
  • USARA
  • USARA Activity Check-in
  • USARA Meeting Attendance
  • USARA Member Check-in
  • USARA New Member
  • USARA Volunteer Log
  • Website Feedback
  • Wilkes Recovery Revolution Kiosk
  • WRR Kiosk
  • Uncategorized
Faces & Voices of Recovery Data Hub

Step 1 of 3

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  • Check-In

    Please Check-In to an activity!

  • Request Contact

    Please provide the following information and we will get back to you shortly.
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    Section Break

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  • Your participant short code is your first initial, last initial, birth month, day and year in the following format: FL01021901 Where First Last's birth date is 10/21/1901.
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    Non-Participants can not check in for one-on-one sessions.
    Please fill our New Participant form below!
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    Request Contact

    Please provide the following information and we will get back to you shortly.
  • Your participant short code is your first initial, last initial, birth month, day and year in the following format: FL01311990 Where First Last's birth date is 01/31/1990.

  • New Participant

    Please create your new participant record.
  • If you don't have an email address, please input "no@email.com".
  • Please enter (000)-000-0000 if you do not have a phone number

  • Demographic Information

  • MM slash DD slash YYYY

  • Contact Preferences

  • The purpose of the disclosure authorized in this consent is to receive recovery support. I understand that my alcohol and/or drug treatment records are protected under the Federal regulations governing Confidentiality of Alcohol and Drug Abuse Patient Records, 42 C.F.R. Part 2, and the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 C.F.R. Pts. 160 &164 and cannot be disclosed without my written consent unless otherwise provided for in the regulations. I also understand that I may revoke this consent at any time. I understand and agree to the following: 1. I grant permission for a volunteer to call me at the above phone number, email, and/or address to support me in my recovery. 2. Each time the volunteer calls, he/she will be asking me how my recovery is progressing and if I am in need of additional support (i.e., meetings in area, recovery community centers, safe/sober housing, social events, other resources). 3. At the time of the call, if I am in need of a referral to a treatment program or detox unit, I will be assisted in finding a program, if I so desire. 4. If at any time I decide not to take part in this program, I will contact the center or tell the volunteer when he/she calls.

  • Monthly Assessments

    Please complete the following Monthly Assessments. ALL fields are required. You will be completing the Brief Assessment of Recovery Capital, Outcome Rating Scale, and Craving Rating Scale.
  • Your participant short code is your first initial, last initial, birth month, day and year in the following format: FL01021901 Where First Last's birth date is 10/21/1901.

  • Brief Assessment of Recovery Capital(BARC-10)

    Please indicate your level of agreement with the following statements:

  • Outcome Rating Scale (ORS)

    Looking back over the last week, including today, help us understand how you have been feeling by rating how well you have been doing in the following areas of your life, where marks to the left represent low levels and marks to the right indicate high levels.

  • Craving Rating Scale (CRS)