Christian Crisis Hotline l There is Hope In Christ

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
*insurance coverage	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.

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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