Join Sober Peer

Please take a few minutes to complete this form to help us understand how we can best work together to support recovery.

Contact Information


1. Are you licensed or certified by a state(s)? *

2. If you have been the subject of any investigations, reviews, or disciplinary action taken against you by a licensing board related to your practice, then please provide a brief description of the events.*

3. How many years of experience do you have doing this work?


4. Please list your highest level of education - Include institution, degree, and year of graduation.

5. Do you hold any certification(s) or accreditation(s)?*

6. What title do you use to describe your credentials and practice? (e.g. Licensed Professional Counselor, Peer Recovery Coach, Life Coach)

7. Do you maintain the state-mandated level of professional liability insurance?*

8. Do you accept insurance(s) as payment?*

9. What is your National Provider Identifier (NPI) number?

Description of Services

Please write a short description of your services to be shared on your public profile for potential clients to read when choosing a treatment professional. (250 characters max)*

250 / 250

If you provide in patient treatment services, how many total number of beds do you have?*

Select your Specialties or Areas of Focus*


How will you use Sober Peer?

1. On average, how many hours a week are you available to work with Sober Peer?


2. Please check the languages in which you are able to provide services.*


3. Describe your experience coaching online or via a telehealth solution.*

Have you used zoom, go-to-meeting, web-ex, Microsoft teams, or another telehealth platform, etc?


1. How did you hear about Sober Peer?

2. I have read and agree to the Sober Peer Provider Terms and Conditions ?

3. I agree to not use the Sober Peer platform to perform any services for which I am not licensed, certified, or otherwise qualified to provide.