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Type of Session
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Resposible Peer Support
• • •
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Facilitated by
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Length of Session
• • •
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RECOVERY PLAN
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Recovery Plan
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Reasons for starting peer support services
• • •
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Goals the client has been working with Peer on
• • •
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Client's perception on current family and social supports
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Time Started
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Time Finished
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Reasons for starting service
• • •
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Sobriety Date
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Number of Meetings attended
• • •
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Do you have a home group?
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Name of home group
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Do you have a sponsor
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Sponsor's name and telephone number
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Did you talk to your sponsor this week
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What step are you on with your sponsor
• • •
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Using thoughts
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Anxiety
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Cravings
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Treatment Considerations Being Addressed
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Recovery Goals worked on/accomplished
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What did you do to cope without using
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Seemed to benefit from the session
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Participated in session topics
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Treatment considerations being addressed
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Treatment Goals being met
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Individual Contributions This Session
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ELECTRONIC SIGNED FIELD
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signed by pin#
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signed by pin#
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