Alcohol Recovery Maintenance Check-In
Use this form to reflect on your progress, share your experiences, and support your ongoing recovery journey.
Full Name
*
First Name
Last Name
Date of Check-In
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How many days have you maintained sobriety since your last check-in?
*
Have you experienced any cravings or urges to drink since your last check-in?
*
No cravings or urges
Mild cravings or urges
Moderate cravings or urges
Severe cravings or urges
What emotions have you experienced most frequently since your last check-in? (Select all that apply)
*
Calm/Peaceful
Anxious/Nervous
Happy/Content
Sad/Down
Angry/Irritated
Lonely/Isolated
Other
Please rate your overall mood over the past week.
*
Very Low
1
2
3
4
5
6
7
8
9
Very High
10
1 is Very Low, 10 is Very High
Have you attended any support meetings or reached out to your support system since your last check-in?
*
Yes, attended meetings and/or reached out
No, but I plan to
No, and I do not plan to
Please list any triggers or challenging situations you encountered since your last check-in.
*
What coping strategies or tools did you use to manage cravings or difficult emotions?
*
What goals or intentions do you have for your recovery until your next check-in?
*
Is there anything else you would like to share or discuss? (Optional)
Submit Check-In
Should be Empty: