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Comments and Questions

You may contact us by filling out our question/comments form below. All information you submit using this form is completely confidential.

 

  * required fields
first name
last name
phone number
*e-mail address
*please re-verify exact
e-mail address
this request is for myself   family member    friend
at this point, are they ready and willing to go to rehab? yes   no   maybe
 
preferred geographic location(s)
city or cities
state or states
*zipcode
willing to consider other possible options / locations yes    no    maybe   
level of care Detox
Inpatient (full time)
Outpatient (part time)
Not sure

 

person's age group

 

Adult - 24 and over
Young Adult - 18 to 24
Adolescent - 17 and under

 
dependency issues Alcohol
Drugs
Medications
Other

 
mood disorders Depression
Anger
Bi-polar
Anxiety
Other

 
*insurance coverage Medicaid
Medicare
Any Type of Private Health Insurance
U.S. Military
State-financed (Tenncare, Medical, etc.)
Other ( please explain below )
None
if Other
If necessary , how much out-of-pocket funding might be available for private rehab ? None
$1-$2,500
$2,500-$7,500
More than $7,500
Not sure

 

 

If necessary, is it ok to call you Yes
No

 
If yes, is it ok to leave a message Yes
No
Not Applicable



 
any and all additional facts and background information you feel is pertinent
  NOTE: All information is protected by HIPPA (Health Insurance Portability and Accountability Act of 1996) regulations.
 

 

 

 


Contact Us by Phone

All calls are completely confidential. As a licensed health care facility, we must abide by the strict laws protecting individual privacy. For your convenience, our staff is ready to respond to your inquiries, 24 hours a day 7 days a week. We provide the most accurate information and answers, quickly and anonymously.

If you or someone you know needs help, pick up the phone and call us right now:

   

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