Phone
Menu
24h Helpline
Treatment
Online Programs
Recovery A-Z
Expert Answers
Blogs
Help is one phone call away.
844.906.0660
Cancel
×
Request a Confidential Assessment
Form input is transmitted in secure encrypted format. We are bound by a professionally audited privacy protection code and will not share, sell, or willfully permit unauthorized access to your contact information.
24-hrs Helpline
In order to best assist you with an urgent addiction problem, we recommend that you contact us by calling the toll-free number below. Our counselors are available around the clock 7 days a week.
(844) 906-0660
Connect Now
Having any problems with work or school?
Yes
Maybe
No
Please describe:
Having any family or social problems?
Yes
Maybe
No
Please describe:
Having any financial difficulties?
Yes
Maybe
No
Please describe:
Having any legal problems?
Yes
Maybe
No
Please describe:
Had any prior treatment?
Yes
Maybe
No
Please describe:
Assessment For
Please select...
Myself
Family
Friend
Coworker
Other
Your First Name
&nbps;
Your Last Name
&nbps;
Email Address
&nbps;
Family Member's First Name
Family Member's Last Name
Friend First Name
Friend Last Name
Coworker First Name
Coworker Last Name
Other First Name
Other Last Name
Financial Situation
Please select...
PPO Insurance
HMO Insurance
Cash Pay or Private Pay
Family/Friends
State Insurance/Medicaid/etc
Need Financial Help
Phone
&nbps;
Call me ASAP
ZIP Code
&nbps;
State
&nbps;
Select State...
Outside US
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Age
&nbps;
Please send me email updates!