How to Get a Loved One into Treatment | CIVIQ Health

i CIVIQ Health COVID-19 Response & Updates

Do you have a friend or a loved one who is struggling with the disease of addiction? Fill out our contact form below and an Admissions Coordinator at CIVIQ Health will reach out to help.

Parent / Friend Contact Information
Name*
First Last
Email*
Phone*
Loved One Information
Name*
First Last
Email*
Phone*
Comments/Questions

Parent / Friend Contact Information

Loved One Information