recovery fitness club provider questionnaire
Provider Questionnaire
Treatment Center/ Facility Name
Primary Contact Name
Program Location (City/State)
Role/Title
Work E-mail
Phone Number
Levels Of Care *
 Detox 
 RTC 
 PHP 
 IOP 
 Mental Health 
 Sober Living 
 Other 
For multiple levels of care, select other.
Briefly Describe Population
Number Of Clients *
 1-15 
 16-40 
 41-80 
 80+ 
Have you previously offered fitness or wellness services?
 Yes 
 No 
If yes, what worked or what challenges did you face?
What would success look like after partnering with RFC?
How can RFC support your clinical and operational goals?
What's the biggest obstacle your clients face during treatment or aftercare?
I consent to RFC storing my responses for program personalization.
 If yes, please check. 
Confidential — used only to personalize your program.