Get Started | KCB Recovery

Tell us about you

  • About You
  • Experiences
  • Your History
  • Preferences
  • Get Started

What is your Name?

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What is your Email Address?

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What is your phone number?

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What Country are you from?

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What is your gender?

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What is your age?

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What is your Relationship Status?

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Do you consider yourself to be religious?

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Over the past 2 weeks, have you been bothered by any of the following problems:

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How difficult has these problems made it for you to get along with others or take care of thing at home or at work?

When was the last time you thought about suicide?

Are you currently experiencing anxiety or panic attacks?

Are you currently taking any medications?

Are you currently experiencing any chronic pain?

Have you every been in counselling or therapy for your drinking before?

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How would you rate your current Physical Health

How would you rate your current Mental Health

How would rate your current eating habits?

How would you rate your current sleeping habits?

Are you currently experiencing overwhelming sadness, grief, or depression?

How often do you drink alcohol?

Are there any specific preferences for your Coach?

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What brings you here?

What are you looking to achieve

Please specify (in a few sentences) a bit more about your situation and what you are looking to achieve. This will give your coach a good understanding of where to start.

How did you hear about KCB Recovery?

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