Apply for Sober Living

Applicant Information
Your Name *
Your Name
Your Phone Number *
Your Phone Number
When do you want to enter Real Deal? *
When do you want to enter Real Deal?
Date of Birth *
Date of Birth
Your Address *
Your Address
Do you own a vehicle? *
Do you have health insurance? *
Person Financially Responsible
Their Name
Their Name
Their Phone
Their Phone
Treatment and Sobriety
Prescription Medication
Name, Dosage, and reason for taking
Name, dosage and reason for taking
Name, dosage and reason for taking
Name, dosage and reason for taking
Legal Issues
Signatures
Applicant Signature *
Signature Date *
Signature Date

This information will be kept confidential and only used for emergencies. Real Deal agrees never to share private information except during medical emergencies to relevant professionals and immediate family members. All private information is stored on our secure website platform. If any policy changes regarding privacy are made, all previous applicants will be emailed with updated terms. To update any information in the application or for any concerns around misuse of personal data, please email us at contact@realdealtx.com.