Area 69 (Utah)
Treatment Facilities Inventory
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
Other Please Specify:
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
Monthly Frequency of A.A. contacts:
Last A.A. Contact:
Your Name:
Service Position:
Name of A.A. Group:
Open / Closed?
Current GSR: