Opioid Recovery Plan Agreement
Participant Name
Date of Agreement
1. Recovery Goals
Short-Term Goals
Long-Term Goals
2. Support System
Support Persons/Contacts
3. Treatment Plan
Medications/Interventions
Therapy/Counseling Details
4. Relapse Prevention Strategy
Triggers & Warning Signs
Plan for Coping with Triggers
5. Agreement & Commitment
Participant Commitment Statement
Participant Signature
Date
Provider/Counselor Signature
Date