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Please complete the following form if you’re a Highly Accountable Professional that would like Parkdale to assist you with building your recovery portfolio and finding a job in your field.  If you’ve reached this page in error, please visit our contact page to get in touch regarding your specific needs. We will never share your information with a third party without your consent nor will we contact anyone on your behalf without your explicit written permission. Parkdale adheres to all HIPAA privacy rules and regulations. Your information is safe with us.

Have you registered on this website before? *
If you have NOT previously registered an account on this website before, select NO.
Name *
Name
Are you enrolled in Parkdale's Aftercare Program *
*Documented* clean and sober means that you have proof of sobriety via random urine drug screens and/or compliance with a monitoring program.
What is your profession? *
Are you involved in a state professional's assistance program? *
Yes - inpatient at a program NOT specifically for HAPs No - but I have been to Intensive Outpatient Programming (IOP) or a similar outpatient treatment program No