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Peer Services Request – Paid Subscription

Request Peer Recovery Support Services

Please fill out the form below and select your peer services subscription type to get connected to a RecoveryLink peer specialist today!

First Name *

Last Name *

Phone Number *

Email *

What additional recovery support services are you interested in? *

Family Peer Support

Online Recovery Meetings

Digital Recovery Yoga

Digital Recovery Cross Fit

Guided Meditations

Other

Please select all that apply *

I am currently insured

I am in a treatment program

I live in a recovery residence

I am a veteran or currently in the military

I am a student

I am on SSI/Disability

I have a mental health disorder

I have a substance use disorder

I have another behavioral health disorder not listed

Do you currently consider yourself a person in recovery? *

Gender Identity * Gender Identity

Why are you interested in recovery support services? *

Billing Info

Which peer support subscription plan would you like? *

Address *

Address

Street Address

Building/Apartment/Suite #

City

State/Province

Zip/Postal

Credit Card *

I agree to the RecoveryLink terms of service, the recoveree portal user agreement, and to be billed on a recurring basis until I cancel for the select subscription. *

No Yes

About Us

RecoveryLink™ is a digital recovery technology company delivering peer support services at the touch of a button.

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contact@myrecoverylink.com

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