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Recovery and Re-Entry into the Community
Please Note: This form is intended to be used as a way for family members and supportive-others to help clients who are in DOC substance abuse treatment to be more successful. The form will only be considered if it is filled out at the invitation of an inmate who is enrolled in a DOC substance abuse treatment program.
 
Family Members and Supportive-Others,
Someone who is in substance abuse treatment has invited you to be a part of his or her recovery from substance abuse and criminality and to be a part of his or her re-entry into the community. To be a part of that process, please fill out the form below and then click "submit" when you are ready to send it. If a client did not invite you to fill out the form, it will be discarded. Please note, your responses will be shared with the client in a therapeutic session with the intent that the information will be included in his or her treatment planning.

 

 

Your NamePerson in Recovery's SID numberPerson in Recovery's Name
Mailing Address  Relationship
 
CityStateZip

What do you feel would help your relationship with this person in recovery ?


What areas do you feel this person needs to work on the most?
(check all boxes that apply)
  • Accountability
  • Employment
  • Morals
  • Responsibility
  • Addiction
  • Health
  • Negativity
  • Self-Esteem
  • Anger
  • Honesty
  • Networking
  • Selfishness
  • Commitments
  • Humility
  • Parenting
  • Setting Goals
  • Communication
  • Integrity
  • Relationships
  • Spirituality
  • Criminality
  • Love
  • Reliability
  • Trust
  • Education
  • Financing
  • Respect
  • Vulnerability

Questions, Comments, or Suggestions: