Tell us a little about your situation.
It should take between 10-15 minutes to answer these 10 questions. You'll hear back from us within one bussiness day.
Question 1 of 10
Name, age, phone number, email address?
Question 2 of 10
Tell me a little about the situation you're wanting help with?
Question 3 of 10
What are your top motivators for making this change?
Question 4 of 10
What have you tried in the past? (counseling, treatment, 12-step meetings, other..)
Question 5 of 10
Why is this the right time to address this problem?
Question 6 of 10
What outcome are you hoping for?
Question 7 of 10
There are a lot of options out there...Why do you think this is the right program for you?
Question 8 of 10
Amber typically sees clients on Tuesdays and Wednesdays during regular work hours. Will this work for your schedule?
Question 9 of 10
Are you wanting to start this month or next?
Question 10 of 10
Anything else we should know?