The Drug Rehab is a free service to assist you in selecting the proper addiction treatment solution. All information received is confidential. Response time is usually immediate and is in the form of a confidential e-mail. In some instances phone contact may be appropriate and necessary to better assess the situation, or in the case of an emergency where the call was requested by the individual. In the event of a phone call the counselor will only identify themselves to the contact person listed below, and will advise all others that this a personal call and will not disclose who we are or why we are calling. In assessing the problem and deciding on treatment options, several factors that are typically used in assessing an individual’s level of addiction. These factors include:

  • Prior alcohol and drug use history
  • Family history and Ethnic/Cultural background
  • Social history
  • Legal history
  • Educational history
  • Occupational history
  • Medical history
  • Psychological and behavioral problems

Below you will find questions pertaining to these areas, it is important that you answer them as accurately as possible. This information is requested, however it is not required for a referral:

Please fill-out the form below so we can assess and refer your information to the treatment center which best suits your needs.