Support group 
sign-off form
Consent to Release Confidential Information
Form

Here are some extra forms and features if needed, that may be helpful to you.

CLICK ON THE IMAGES TO DOWNLOAD FORMS.

Optional Forms & Features

Fill out, sign and fax or email us this form if you would like us to submit a copy of your evaluation or certificate for you.

 

This is a must have as it is required by law before we can submit any of your confidential paperwork anywhere.

 
$45.00

EXPRESS

SERVICE FEE

If you need your Alcohol / Drug / DUI evaluation processed in 2 days - we may be able to do so; there is a $45.00 fee for this.

(Please note; You will still need to obtain and submit ALL of the necessary documents outlined in the evaluation instruction sheet before we can proceed.)

We do not guarantee this is "doable" but we will be happy to try & will refund this fee 100% in full, if we cannot.

Use this document if you are required to attend support group meetings as part of your recommended interventions or if you feel the need on your own.  Have the group leader sign off on it.  They are familiar with this process.

Ask for a sponsor if you feel that you may have a problem.  

Live Video Evaluation upgrade fee  $25.00

 

If this is your 2nd offense DUI/DWI and you were given permission to do a Live Video Evaluation, click above for the up-grade and then contact us for an appointment and continue to the members only Alcohol / Drug / DUI Evaluations area -use your pass-code and get started with the paperwork.

 
$55.00
 
Counselor Approval required.
Supplemental Treatment hours for court ordered classes
Click on image to get workbook
Road Back 
Club $79  sign-up fee

If you are short on hours then this treatment supplement may work for you.  This is by counselor approval only.

We offer a treatment certificate in the amount you need by reading through this workbook and choosing 5 to 7 excersizes out of this workbook.   Your counselor will confirm the treatment hours.   

COLLATERAL WITNESS
Click images if you need a Collateral Witness Release and support form for DUI evaluations
(you will need both forms)
Release 
Form
Support 
Form

Use these forms if a collateral witness report is required.   

 
$45.00
Criminal 
 Findings Report

If you have been given assistance to help jump start you on your journey back, then please remember this club in the future. This is a not for profit club of people helping people. Many individuals and families request assistance due to the high costs of court related requirements.  If you were once in need.  It is your responsibility to pay it forward when you are back on your feet and keep this fund active to help others. Proceeds go to assisting indigent families     

Road Back 
Club

If you would like to make a donation or if you have been helped by this fund and would like to give back to help those in need of financial services for Alcohol and Drug related issues, Cornerstone Recovery Coaching will match what you put in for related services to help those in need to get on their feet.    

 
$35.00
Research 
Request

If you would like to receive a copy of the criminal findings report that was obtained by our agency through various available legal and public channels. You may order a copy of this record by clicking on the Buy Now button above.  By ordering this paperwork you are agreeing that you are aware that Cornerstone Recovery Coaching does not guarantee the accuracy /or validity of the results therein, and that these results were not developed by our organization.  We simply offer you an opportunity to see what activity may be attached to your personal information to allow you the opportunity to dispute such findings, if you feel they may be inaccurate, before the final evaluation is submitted.  This report usually takes between 24 and 48 hours during business days to receive by email.  

Cornerstone Recovery Coaching charges 35.00 for state specific paperwork required by the courts for your case.  If you have state specific paperwork that needs to be researched and completed please register for that here. You can then fax or email the specific paperwork and we will attach it along with your evaluation or assessment etc. m.  

  • Substance Abuse and Mental Health Services Association

  • Internat'l Credential & Reciprosity Consorteum

  • Division of Alcohol and Substance Abuse

  • Department of Health and Human Services Certified

  • Multiple State Credential Board (IC&RC)

  • National - Addiction Severity Index

  • Department of Transportation - Substance Abuse Professional

  • National Association of Addiction Professionals

  • Governor's Highway Safety Administration

  • Professional Christian Counseling and Coaching Association

  • Anger Management Credentialing

  • Email Address: support@CornerstoneRecoveryCoaching.com

 

 

  • SAMHSA.GOV

  • IC&RC Approved Program Provider #804150

  • DASA - DUI / DWI Service Provider 

  • DHHS

  • IAODAPCA / ICB  Approved Provider #no.29696.il

  • ASI

  • D.O.T. / SAP  Approved Provider # 15331103

  • NAADAC

  • GHSA

  • PCCCA

  • Anderson & Anderson

  • Cornerstone Recovery Coaching LLC

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