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Please call our national center if this is an intervention emergency at 800.399.3612 or fill out the Request Help Now form.

We have staff standing by 24 hours a day, 7 days a week.

 

 

 

 

 

 

 



   
State of Residence:
   
Name:
   
Phone:
   
Email:
   
Type of Intervention::
   
Intervention Date:
   
Comments:

 

 

All information will be kept strictly confidential.

Intervention and Treatment Referral


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