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alpenglow Recovery Center

Confidential intake

Let's start with a few questions.

Five short steps, about five minutes. Answer what you can; "not sure" is always a fine answer. This is a request to talk, not a commitment to anything.

This form is not for emergencies.

If someone may be overdosing (will not wake up, slow or no breathing, blue lips), call 911 now and give naloxone if you have it. In crisis, call or text 988. Poison Help: 1-800-222-1222.

Demo notice: this is a sample website. The form works so you can try it, but it sends nothing and stores nothing.

Step 1 of 5: Who needs help

  1. Who
  2. Use
  3. Insurance
  4. Talking
  5. Review

Who needs help?

Either is welcome. Families often call before their person is ready.

How old is the person who needs help?
Fictional sample site by SearchPod