Contact us.Spiritualwest12@gmail.com19 Bramhall StreetPortland, ME 04102 Legal Name: * First Name Last Name DOB Phone: Email * Current Address/City/State Date of Last Use Drug of Choice How do you intend to initially afford sober living? Do you have any current legal issues? Are you required to register as a sex offender? Do you have any current medical conditions? List of all current medications (prescription and over-the-counter) Are you currently in treatment? If so, where? If in treatment, who is your case manager? Expected discharge Date? Expected move in date? Have you been in treatment in the past for alcohol/drug addiction? If so, where? Emergency contact name Emergency contact phone number Where did you hear about The West House? Please explain why sober living is necessary for your recovery Thank you!