8-Week Family Intensive Enquiry Form
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Your name
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Please provide your first and last name.
This field is required.
Email address
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We will use this email to contact you regarding your enquiry.
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Phone number
Optional. Email is the primary contact method unless we arrange a call.
This field is required.
Where are you located?
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Country, state, or time zone is enough.
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Who is completing this enquiry?
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Select your relationship to the person.
Select an option
Parent or caregiver
Partner or spouse
Adult child
Sibling
Other family member
Friend or support person
Treatment provider or professional
Other
This field is required.
What stage is your loved one currently in?
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Choose the option that best fits your current situation.
Select an option
Actively using and not currently in treatment
Considering treatment
In residential treatment
Preparing for discharge from residential treatment
In outpatient treatment
Recently discharged from treatment
In early recovery
Relapsed or returned to use
Not sure
Other
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What type of addiction or issue is involved, if you feel comfortable sharing?
Select any that apply. You can choose “prefer not to say” if you would rather not share this here.
Alcohol
Drugs or substances
Gambling
Prescription medication misuse
Multiple substances or behaviours
Mental health concerns alongside addiction
Not sure
Prefer not to say
Other
What is the main reason you are enquiring about the 8-Week Family Intensive now?
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For example: upcoming discharge, conflict at home, uncertainty about boundaries, treatment planning, relapse concerns, living arrangements, or family overwhelm.
This field is required.
What decisions or challenges feel most urgent at the moment?
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Select any that apply. This helps identify the areas where your family may need the most support.
Whether they return home
What boundaries need to be in place
How to support recovery without enabling
Financial support or money requests
Conflict between family members
Communication with the treatment provider
Preparing for discharge
Relapse concerns
Impact on children
Safety concerns
Housing or living arrangements
Emotional overwhelm
Not sure yet
Other
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Are there any immediate safety concerns for you, your loved one, children, or anyone else involved?
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If anyone is in immediate danger, please contact emergency services or a specialist crisis support service in your area. This form is not monitored for emergencies.
No
I'm not sure
Yes
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Is your loved one currently connected with professional treatment or support?
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Choose the option that best describes their current support, if any.
Yes, residential treatment
Yes, outpatient treatment
Yes, counselling or addiction support
Yes, medical support
No
Not sure
Prefer not to say
Other
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Are you enquiring in collaboration with a treatment provider or professional service?
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This helps me understand whether this enquiry is family-led or connected with a treatment or support service.
No
Yes
Not yet, but I may want to involve them
I am a treatment provider/professional enquiring on behalf of a family
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If a treatment provider or professional service is involved, please share any relevant details.
Optional. Please do not include confidential clinical information unless you have permission to share it.
This field is required.
What are you hoping this intensive will help your family with?
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This intensive focuses on boundaries, family stability, decision-making, communication, expectations, and emotional steadiness. It does not provide therapy, medical treatment, legal advice, or crisis intervention.
This field is required.
Who else may need to be involved in this work?
For example: partner, co-parent, adult children, siblings, parents, treatment provider, or other support people.
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What is your general availability for a brief clarity call?
Please include your time zone if possible.
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Application acknowledgement
I understand this is an enquiry/application form and submitting it does not create a coaching relationship, guarantee availability, or guarantee that the 8-Week Family Intensive is the right fit for my situation.
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Please tick this box to confirm you understand the purpose and limits of this enquiry form.
This field is required.
Scope acknowledgement
I understand this coaching complements clinical treatment and does not replace therapy, medical care, addiction counselling, legal advice, case management, emergency support, or crisis intervention.
*
Please tick this box to confirm you understand the scope of this coaching support.
This field is required.
Email Updates
Yes, I’d like to receive supportive emails, resources, and updates from Why Won’t They Stop? I understand I can unsubscribe at any time.
Optional. Tick this box only if you would like to receive supportive emails and updates from Why Won’t They Stop?
Submit My Enquiry
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