The following applicant has expressed an interest in participating in our program and needs a reference from someone other than an immediate family member.

Please answer the questions below and return this form to our office as soon as possible. We would appreciate an honest evaluation of the applicant.

This information will be kept in strict confidence. It will not be shared with the applicant.

The application cannot be processed until we receive this form. Thank you for your assistance.

We at Restored Warriors want to thank you for your time and efforts in helping this applicant overcome their addiction(s).

All information disclosed is kept in the strictest of confidence and will never be shared with the applicant.