---
title: "Get Help Now — Confidential Intake | Advanced Recovery Treatments"
description: "Complete a free, confidential intake to be matched with cutting-edge addiction and mental health treatment programs that fit your situation."
lang: en
json-ld:
---

[

Advanced Recovery Treatments 

](/)

Treatments 

[About ](/about)[Blog ](/blog)

Contact 

[Get Help Now](/intake)

Confidential Intake

# Get Help Now

The more you share, the better we can match you to the right treatment. Every field is private and reviewed only by our team. Skip anything you're not ready to answer.

100% Confidential  Free Service  24h Response 

**If this is an emergency or you are in crisis**, please call or text **988** (Suicide & Crisis Lifeline) or **1-800-662-HELP** (SAMHSA, 24/7). This form is for matching to non-emergency treatment.

## 1\. Who is filling this out?

So we know who we're speaking with.

Myself A loved one 

Your full name \* 

Email \* 

Phone \* 

Preferred contact methodPhone call 

Best time to reach you

## 2\. About the patient (you)

Just enough so we can find appropriate options.

First name \* 

Age \* 

Gender (optional)

City & state \* 

Willing to travel for treatment?

Local only Within my region Anywhere in the U.S. 

## 3\. What you're dealing with

Be as candid as you're comfortable with — it stays private.

Primary concern \* 

Substances involved (check all that apply)

Alcohol Opioids / Heroin Prescription painkillers Benzodiazepines (Xanax, Klonopin, etc.) Cocaine Methamphetamine Cannabis / Marijuana Nicotine / Vaping Prescription stimulants (Adderall, etc.) Sleep medications Other 

Behavioral concerns (check all that apply)

Gambling Gaming / Internet Sex / Pornography Shopping Food / Eating Relationships / Codependency 

How long has this been going on?

When was last use?

Typical daily amount / frequency

## 4\. Mental health & medical

Co-occurring conditions are common and important for matching.

Diagnosed or suspected mental health conditions

Depression Anxiety PTSD / Trauma Bipolar disorder ADHD Eating disorder Schizophrenia / Psychosis Personality disorder Other 

Current medications (optional)

Thoughts of suicide or self-harmNo 

If you're in immediate danger, please call **988** right away.

Other medical conditions (optional)

## 5\. Treatment history

Have you (or the patient) received treatment before?No prior treatment 

What's worked or not worked? (optional)

## 6\. Practical considerations

So we don't waste your time on options that won't fit.

Insurance provider (optional)

Budget situationNot sure yet 

Treatment types you're interested in (check all that apply)

Medical detox Inpatient / Residential Partial hospitalization (PHP) Intensive outpatient (IOP) Outpatient therapy Medication-assisted treatment (MAT) Ketamine-assisted therapy TMS EMDR / Trauma therapy Dual diagnosis program Family therapy Sober living Not sure — please advise 

How urgently do you need help?Within the month 

## 7\. Goals & anything else

What does success look like for you?

Anything else we should know?

I understand Advanced Recovery Treatments is a free educational and matching service, not a medical provider, and I consent to being contacted about treatment options. My information will be kept confidential. Submit Intake

Confidential — never shared without your permission.

[

Advanced Recovery Treatments 

](/)

Connecting individuals with cutting-edge addiction recovery treatment centers nationwide.

#### Addictions

-   [Drug Addiction](/treatments)
-   [Alcohol Recovery](/treatments)
-   [Behavioral Addictions](/treatments)
-   [Dual Diagnosis](/treatments)

#### Advanced Therapies

-   [Ketamine Therapy](/treatments)
-   [NAD+ IV Therapy](/treatments)
-   [Neurofeedback](/treatments)
-   [Holistic Recovery](/treatments)

#### Resources

-   [Find a Treatment Center](/treatments)
-   [Get Help Now](/contact)
-   [Recovery Blog](/blog)
-   [About Us](/about)
-   [Contact](/contact)

#### Company

-   [About](/about)
-   [Privacy Policy](/privacy)
-   [Terms of Service](/terms)

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