Substance Use Resource Guide Request Form
Please complete this form if you would like a Substance Use Resource Guide for family members mailed directly to you. Please allow 1-2 weeks for delivery. If you would prefer, call the Resource Hotline to pick up directly from the Helpline Center. To contact the Resource Hotline, call 1-800-920-4343.
Name
*
First Name
Last Name
I am requesting as:
*
a family member.
someone looking for support.
as a professional.
Prefer not to disclose.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
How many manuals are you requesting?
View the Resource Guide here
HLC Comments:
Submit
Should be Empty: