Begin Your Journey

Resident Intake Form

Take the first step toward structured, supportive sober living. Complete the form below and our admissions team will be in touch within one business day.

Personal Information

First Name *

Last Name *

Date of Birth *

Gender Identity

Phone Number *

Email Address

Current Address / City

Recovery Background

Primary Substance(s) of Use *

Alcohol Opioids / Heroin Methamphetamine Cocaine / Crack Cannabis Benzodiazepines Other

Current Sobriety Date or Approximate Length of Sobriety

Prior Treatment History

Residential / Inpatient Intensive Outpatient (IOP) Detox Previous Sober Living No Prior Treatment

Are you currently enrolled in any outpatient or mental health treatment?

Are you currently on Medication-Assisted Treatment (MAT)?

Housing & Referral

Desired Move-In Date *

How were you referred to Rainier Crest Residency? *

Referring Organization or Person (if applicable)

Referral Contact Phone or Email (if applicable)

Do you have transportation needs?

Emergency Contact

Emergency Contact Name *

Relationship

Emergency Contact Phone *

Additional Information

What are your personal goals for your time at Rainier Crest Residency?

Any questions, concerns, or additional information you would like us to know?

Acknowledgment

By submitting this form, I acknowledge that the information provided is accurate to the best of my knowledge. I understand that submission of this form does not guarantee residency placement and that a member of the Rainier Crest Residency admissions team will follow up to complete the intake process.

I agree to the above acknowledgment and consent to being contacted regarding my application. *

Fields marked * are required. Your information is kept strictly confidential.

Need Help Applying?

Our admissions team is happy to walk you through the process by phone.

833-641-9779

What Happens Next?

We review your application

Within one business day

Admissions call / interview

We discuss your needs and answer questions

Placement decision

Acceptance, waitlist, or referral

Welcome home

Move-in orientation with your house manager

Confidentiality

All information submitted is kept strictly confidential and is used solely for the purpose of evaluating your residency application, in accordance with applicable privacy laws.