Treatment Facilities Inventory - Utah Alcoholics Anonymous

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: