Call Us - 888-629-6707
Quick Self-Assessment
"
*
" indicates required fields
Step
1
of
7
14%
Which substances are you currently using?
Alcohol
Drugs
Both
None
How much do you spend on your habit?
Less than $50
$50-$100
$100-$200
Over $200
Are you struggling with your mental health?
Yes - Anxiety
Yes - Depression
Yes - Other
No
Are you willing to go to treatment in California?
Yes
No
Do you have Insurance?
Yes - HMO / PPO
Yes - Medi-Cal /Medicare /Medicaid
No
Other
Click HERE for State Resources
How urgent is it for you to start treatment?
Immediate
Next Month
6 Months
Next Year
First Name
*
Last Name
Your Email
*
Your Phone
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