Drug Rehabilitation Center Substance Abuse Treatment Programs Drug and Alcohol Rehab Services Treatment Recommendation Service Online Assessment
Call toll free
1-800-515-3277 For Help Now!
This online service is provided free of charge as a public benefit
and all information received from clients is confidential. Response
time is usually 24 hours or less, and usually is in the form of
a confidential e-mail first, then a possible telephone interview.
In most instances a DARS counselor will attempt phone contact to
better assess the situation. In the event of a phone call DARS will
only identify themselves to the contact person listed below, and
will advise all others that this is a personal call and will not
disclose who we are or why we are calling. The below request for
information is gathered to help the placement specialist better
determine an individual's needs and successfully match them with
the best possible level of care available for them. Please fill
out the confidential online assessment form to the best of your
ability. All fields are not required, and remember - disclosing
personal information is not required for assistance or a treatment
referral. Confidentiality is of the utmost importance here at Drug
and Alcohol Rehab Services. We're here to help.
Thank You
Drug and Alcohol Rehab Services/Consultants
Confidential Online Assessment
Fill Out The Form Below To Receive A Call From One Of Our Qualified Addiction Specialists Note: any and all information submitted is completely confidential
First Name:
Last Name:
E-mail Address:
Phone Number:
Evening Phone:
Cell Phone:
State:
You are contacting Drug and Alcohol Rehab Services for:
Self
Family Member
Husband
Wife
Friend
Employee
Patient
Client
Other
If Contacting Drug and Alcohol Rehab Services For Someone Other Than
Yourself, Please Enter Their Name Below:
Select Your Time Zone:
Best Time To Call:
Drug History
What Is The Primary Drug of Abuse?
Method of Intake?
What Is The Secondary Drug of Abuse?
Method of Intake?
At What Age Did The User First Take Drugs?
How Old Is The User Now?
At What Age Did The User's Life Begin To Be Unmanageable?
Presently What Are The Resulting Problems of The User's Addiction?
What Is The Family's Attitude Toward The User's Addiction?
Does The User Admit To Having A Problem?
yes
no
Does The User Want Help ?
yes
no
Treatment History
How Many Times Has This User Been In Treatment for Their Addiction?
How Many of These Involved The 12-Step (AA/NA Model) Approach To Recovery?
Was There Any Success With Any Of These Treatment Episodes, and if so, what was the length of sobriety achieved?
Medical History
Does The User Have Any Known Medical Conditions?
If So, Please List The Condition(s) And Any Necessary Details:
Has This Person Ever Been Diagnosed With Any Psychiatric Disorders?
If So, Is He / She Currently On Medication For A Psychiatric Disorder?
If So, Please Specify Medications Taken:
Does The User Have Medical Insurance?
Does The User Have Legal Issues?
If So, Please Describe
Please Provide Us With Any Other Information And Any Questions You May Have In The Area Below
Please retype the letters/numbers you see in the box.
Drug and alcohol rehab services offers a comprehensive network of treatment referrals for alcoholism rehabilitation, drug addiction, substance abuse, dual diagnosis, and chronic relapse clients. Click here to submit a no cost online assessment.
Drug and Alcohol Rehab Services has countless therapeutic drug rehabilitation, alcohol rehab and outpatient program referral locations throughout the nation and the world
We have seen, in recent years, an enormous change in how addicts
and alcoholics who become involved in the criminal justice system
are regarded.
Our judges no longer want to lock away addicts and alcoholics. Judges
and prosecutors want substance abusers to stop using. If addicts
and alcoholics stop using drugs and alcohol the criminal behavior
will stop.
The alternative is drug and alcohol rehabilitation prior to
sentencing. DARS counselors and its facilities are familiar with the
criminal justice system and how to navigate what appears to be an
endlessroad to nowhere.
