ADMISSIONS INQUIRY

BEGIN YOUR JOURNEY

Are you or someone you know looking for a treatment program? Please complete the following form to help us understand your needs. A member from the ABC team will contact you within 2-3 business days to begin intake and schedule your initial appointment. If this is a medical emergency, please call 911.

First Name

Email Address

Last Name

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Service Requested (check all that apply)

3.3 Residential Treatment

3.1 Residential Treatment

Substance Abuse Treatment

Adult - Outpatient Mental Health Treatment

Child - Outpatient Mental Health Treatment

Medication Management

Psychiatric Rehabilitation Services

I declare that the info I’ve provided is accurate and complete. I have completed the form on my own behalf or I have received permision from the applicant to submit this form on their behalf.

A member from the ABC team will contact you within 2-3 business days to begin intake and schedule your initial appointment. If this is a medical emergency, please call 911.

410-292-0130

ADMISSIONS INQUIRY

BEGIN YOUR JOURNEY

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