Contact Us We would be happy to help you take the first step to recovery. Please answer a few questions below to let us know a little bit more about your situation. Name Phone Number Email Please list the drugs/narcotics involved How long have you been struggling with addiction? Are you submitting this form for yourself or a loved one? How soon would you like to begin? (asap, 1 week, 1 month, longer) Have you had prior attempts at treatment? If so how many? Message Send