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Recovery Readiness Assessment
Name
Email
Why are you seeking help now?
Phone Number
Age
Current Living situation
What substance(s), behaviors, or circumstances are you seeking recovery from?
Are you personally choosing to pursue this program?
Yes
Mostly
Unsure
No
PART 1 — DESIRE FOR CHANGE
1. I genuinely want my life to change.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
2. I am willing to stop living the lifestyle that has contributed to my addiction.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
3. I understand that recovery will require me to change my attitudes, behaviors, relationships, and daily habits.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
4. I am willing to make sacrifices in order to maintain my recovery.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
5. I am entering recovery because I want a different life—not simply because someone else is forcing me to.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
PART 2 — WILLINGNESS TO SURRENDER
6. I am willing to admit that the way I have been living has not worked.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
7. I am willing to accept that I do not have all the answers.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
8. I am willing to surrender my own will when it conflicts with the rules and structure of the recovery program.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
9. I am willing to listen to people who have experience in recovery, even when I disagree with them.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
10. I am willing to let God work on areas of my life that I would rather avoid.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
PART 3 — TEACHABILITY & HUMILITY
11. I am willing to receive correction without automatically becoming defensive.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
12. I can admit when I am wrong.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
13. I am willing to learn new ways of thinking and behaving.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
14. I understand that being in recovery does not make me an expert on recovery.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
15. I am willing to follow instructions even when I personally would have done things differently.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
PART 4 — CHRISTIAN FAITH & SPIRITUAL GROWTH
16. I am willing to learn about Jesus Christ and what the Bible teaches about how I should live.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
17. I am willing to participate in Bible studies, prayer, worship, and other spiritual activities required by the ministry.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
18. I am open to allowing biblical principles to influence my decisions and behavior.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
19. I am willing to pray and seek God's direction, even when I do not yet have a strong personal relationship with Him.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
20. I understand that this program is centered around Jesus Christ and that spiritual growth is an important part of the program.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
PART 5 — ACCOUNTABILITY
21. I am willing to be honest with staff about my behavior and decisions.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
22. I am willing to accept consequences when I violate program rules.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
23. I understand that accountability is intended to help me grow rather than simply punish me.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
24. I am willing to be accountable to other people rather than trying to manage my recovery completely on my own.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
25. I am willing to tell the truth even when telling the truth could result in an uncomfortable conversation.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
PART 6 — COMMITMENT TO PROGRAM STRUCTURE
26. I am willing to follow a structured daily schedule.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
27. I am willing to follow the ministry's rules even when I personally disagree with them.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
28. I am willing to give up people, places, and activities that could threaten my recovery.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
29. I understand that freedom in recovery comes with responsibility.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
30. I am willing to put recovery ahead of temporary comfort or personal convenience.
Strongly Disagree
Disagree
Unsure / Sometimes
Agree
Strongly Agree
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