Apply to Clarity House Chicago

Take the first step toward a structured, supportive recovery environment.

Intake Application

Please complete the form below. We'll contact you within 24-48 hours to schedule an intake interview.

First Name *

Last Name *

Phone Number *

Email Address *

Date of Birth *

Sobriety Date *

Employment Status *

Treatment History (Optional)

This information helps us better understand your recovery journey.

Emergency Contact Name *

Emergency Contact Phone *

Preferred Move-In Date

Additional Notes

Thank you for your application! We'll contact you within 24-48 hours to schedule an intake interview.

Our team will reach out within 24-48 hours to discuss your application.

We'll schedule a phone or in-person interview to learn more about your needs.

Once approved, we'll coordinate your move-in date and welcome you to Clarity House.

We're here to answer any questions about our program or the application process.