Referral Form

Service Referral Form

EqualSRQ provides substance use recovery support services to people between the ages
of 18-70. This form can be completed by either an agency or a person seeking recovery
support. We have provided a short self-assessment that will help interested parties determine
if EqualSRQ services will be an effective choice.

EqualSRQ has one on one support available for participants. These services are open to anyone
wanting recovery support and they include 12 step meetings, recovery events and skill building
groups. We also offer free recovery peer services to adults 18-70 who live in Sarasota County.

Recovery Service Assessment

Generally, people wanting to engage in our services meet at least one of the following
criteria. If none of these these apply to you, then EqualSRQ services are not likely to meet
the need you are trying to address. Please check all that apply.

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