INTAKE FORM

Your Intake Form

Getting started on your road toward planning and performing an intervention can feel like a daunting task. It doesn't have to be an overwhelming process. The gift is that you may be saving more than one life. Committing to an intervention for your family may be the most compassionate decision you can make both for your family and the person of concern.

Getting started is simple.

Getting started is as simple as filling out the form below. Your responses will help you assess the situation objectively. It will be clear to you how serious the addiction is and what the ultimate consequences can be.

We're here to walk with you every step of the way.

Take a moment to respond to the questions below. We're here to guide and support you with each step. Your first phone call is complimentary. Call us today with any questions you may have. We'll be delighted to speak with you.

800-909-9714

 

INTERVENTION BACKGROUND INFORMATION

 

Verification

Addiction Calculator