FindingMyRecovery Intake Form

To become a member of Volunteer Behavioral Health’s findingmyrecovery website, you must have had a diagnosable mental, behavioral, emotional, substance use or co-occurring disorder at some point in your adult life.  You must be at least 18 years old, and you must have a valid email address.

If you want to join the Peer Support Center, no email address is required.  

VOLUNTEER BEHAVIORAL HEALTH CARE would like to thank you for your interest in becoming a member of findingMyRecovery!!!  Please take a few minutes to read the following information regarding what you can expect concerning your personal information and services available.

Your permission is being sought for you to take part in the activities included in the findingMyRecovery.org website.

Becoming a member of this website is voluntary and is totally up to you. The personal information collected from you will be part of a larger data base that will include information collected from other individuals involved with this site so that staff of fMR may reach you and other members regarding up-coming events, chat time updates or changes, recovery support and crisis referrals if needed. The information will be kept private as required by law. If you have any questions about the information collected, please contact staff at the following numbers:

Recovery Coach (931)319-0724      Program Manager (931)303-1041

Purpose of Information Being Collected:

Examples of how this information will be used:

To develop and maintain a means of contact with and support for members – focus being on providing available services to members as needs arise.

Describe individuals being served:

Those individuals being served have one or more of the following: Co-occurring disorders, mental health disorders, or substance abuse disorders and have a desire to recover.

Describe services people receive:

Through online social media, individuals can participate in online group meetings and chat sessions as well as  private chats with trained certified peer recovery specialists. Members will be given access to begin to blog and post, complete a relapse prevention plan and obtain recovery coaching  by Certified Peer Recovery Coaches when needed. Members will also have access to referrals for assistance with resources and other services as needed.

Determine which individuals receive which service:

All participants are able to receive all of the services offered through findingMyRecovery.org, though some members may prefer different chat room or group meeting offerings over others. Referral services will be examined and made on an individual basis according to need and request.

Determine the degree to which people improve during services:

Through regular contact with recovery coaches and others in recovery, the goal is to develop and maintain a support system that incorporates utilization of learned coping skills and educational presentations which focus on relapse prevention and healthy living practices to allow individuals to live the life they desire.

What is involved in collecting this information?

Collecting this information will be completed through a pre-screening tool and a short intake form pursuant to VBHCS requirements. You may choose to stop using the website at any time.  You and staff members can determine if the services provided within this website are a benefit to you.

What are the Risks of being involved in this website?

The primary risk is the uneasiness you may feel when talking about personal and sensitive things within a website setting. Staff are aware of this and will assist in reducing uneasiness, however, staff will never require your involvement in any part of this website. Staff’s priority is to maintain your confidentiality while you are utilizing the website.  The only time Staff will share your information is with your express written consent or by court order, except in emergencies or as otherwise required by law. We ask that you be aware that your identity may be discernible by other members of the website, as with any group setting, either online or in person.

What are the benefits to taking part in website activities?

Individuals who are part of the website may benefit by receiving recovery support, learning coping skills and completion of a relapse prevention plan. Also, all who are part of this website may help others understand their triggers and stressors and how to better manage them.

Will my information be kept private?

Medical records that identify you will be kept private as required by law. Federal Privacy Regulations provide safeguards for privacy and security. You will not be identified within the website by:

• Full Name
• Social Security Number
• Address
• Telephone Number
• any other direct personal identifier

What are my rights to withdraw from the website?

You may choose not to be a part of this website at any time. If you withdraw from the website, no further information about you will be collected. You can also tell us not to use the information we already have collected, but you must do this in writing. We ask that you please contact a staff member if, at any time, you decide not to be part of the website activity.

PERMISSION/Understanding:

By signing below, I am stating that I understand and agree to  the following statements:

• At any time, I am free to cease participating in this website without any explanation and that the method involved will not cause any physical harm or pain.
• This/my information is private and confidential, and I will not be identifiable in any way except as is typical within any group setting.
• My privacy will be protected according to the policies of Volunteer Behavioral Health Care and the State of Tennessee’s laws.
• My participation will have no effect on treatment or other services available to me at Volunteer Behavioral Health Care.