Area 69 (Utah)
Treatment Facilities Inventory

This inventory form will be used by the Area Treatment Facilities Standing Committee to gain a better understanding of the AA fellowship's cooperation with treatment facilities in Utah. District standing chairs and committee members will complete the Facility Inventory Forms. The information gathered will only be made available to the Treatment Facilities Standing Committee and will not be shared outside of the fellowship.

Facility Name :
Street Address:
PO Box:
City, State, Zip: ,   
Telephone:
Fax:
E-mail:
   
Type of Facility: (Check all that apply) Licensed
Medical / Detox
Outpatient
Residential / Inpatient
Youth
Prevention
Halfway house
Administrator:
Admin Phone:
Counselor:
Counselor Phone:
Area 69 District:
Type of A.A. Cooperation: Introduction letter
Literature Rack
Panel Presentations
Bridging the Gap Program
Weekly A.A. meeting
Daily A.A. meeting
A.A. Speaker meeting
Other (Please indicate):
Monthly Frequency of A.A. contacts:
Last A.A. Contact: (YYYY/MM/DD)
   
Your Name:
Service Position:
   
Name of A.A. Group:
Open / Closed?
Current GSR:

  

 

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