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Please call our admissions department and speak live with a crisis counselor for a confidential assessment. We take into consideration all factors presented to determine the appropriate level of care and treatment options that are right for you.

If you prefer, you can simply fill out the form below and we will contact you within 24 hours. All information you provide is strictly confidential.

Your Name:*
Email Address:*
Zip Code:
Phone:
Alcoholics / Addicts Name:
Your Relationship to the Alcoholic / Addict:
Current drug(s) they're using:
Zip Code in which they live:
Check if able to travel outside of this area code for treatment?
- Yes
Please fill in any other details regarding the addict:
How did you find us? (please be specific):
Check here to receive Palm Partners email updates:
- Yes
Email
This field is for validation purposes and should be left unchanged.

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