Our House Admissions Please choose a Login    Please choose a Password    First Name    Last Name    Email Address    Home phone number    Work phone number    Cell phone number    Street Address    Age    How did you hear about Recovery at OUR HOUSE, Inc.?    Are you currently in a detox / treatment center?  NoYes   Where?    What medications do you take?    Do you have any medical or physical limitations? (Anything that may prevent you from being able to work.)    Do you have a job?  NoYes   Where?    Are you receiving:  CompensationSSIFood StampsWelfareDisabilityMedical AsstPensionOther  What other source of income do you have?    What job skills do you have?    Marital Status?    Do you have children?  NoYes   Do you pay support?  NoYes   Do you have another place to live?  NoYes   Where?    Phone Number:    Do you own a car or truck?  NoYes   Valid License?  NoYes   Do you have two forms of valid identification?  NoYes   Identification one details:    Identification two details: