Substance Use Recovery Check-In Form
Reflect on your recovery journey and share your progress, challenges, and needs with your support team.
Full Name
*
First Name
Last Name
Date of Check-In
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How are you feeling today?
*
Very Good
Good
Neutral
Struggling
Very Struggling
Since your last check-in, have you used any substances you are recovering from?
*
No, I have remained substance-free
Yes, I have used
If you experienced a relapse, what do you think contributed to it? (Leave blank if not applicable)
How strong have your cravings or urges been in the past week?
*
None
1
2
3
4
5
6
7
8
9
Very Strong
10
1 is None, 10 is Very Strong
What triggers have you noticed recently? (Select all that apply)
Stress
Social situations
Loneliness
Boredom
Negative emotions
Other (please specify)
Which coping strategies have you used since your last check-in? (Select all that apply)
Attended support group/meeting
Spoke with a sponsor/mentor
Practiced mindfulness/meditation
Reached out to friends/family
Physical activity/exercise
Other (please specify)
How would you rate your overall support system currently?
*
1
2
3
4
5
What are your goals or intentions until your next check-in?
Is there anything else you'd like to share with your recovery support team?
Submit Check-In
Should be Empty: