Contact US PHONE: (207) 814-7475EMAIL: info@mainerecoverycollective.com Application Name * First Name Last Name Email * Phone * (###) ### #### Date of Birth * MM DD YYYY Sex * Male Female Non-binary Insurance * Private Mainecare None Other Requested Date of Admission * Briefly describe why you're interested in Maine Recovery Collective * Prescribed Medications * Mental Health Diagnosis * SUD Treatment History * Sober Living History * Anything else you would like to tell us Thank you!
