Treatment for Addictions
to Alcohol & Drugs

We are ready to help! Please take a moment to answer the questions below so we can verify our treatment for addictions is appropriate for you.

ALL OF THE INFORMATION YOU PROVIDE TO US
WILL BE TREATED WITH ABSOLUTE CONFIDENTIALITY.

Please note that required fields are indicated with an asterisk (*).

Please provide your name.
  A value is required.*
Please provide your general contact information below.
Telephone A value is required.*
Email A value is required.*
Please indicate your geographic area.
State/Prov.
Type of addiction: (Check all that apply, choose at least one)
  Alcohol     Drugs
GamblingOther   
Minimum number of selections not met.
What treatments have been tried? (Check all that apply)
  Medical detox
Out-patient program
Counseling
Residential program
AA/NA meetings
Other
No Treatments
What other issues should be addressed? (Check all that apply)
  Depression
Anxiety
PTSD
Fatigue
Abuse
Bipolar Disorder
Chronic Pain
Eating disorder
ADHD
Insomnia
Anger
Other
Please provide any additional information that you feel would be helpful in planning treatment. (Optional)
 

Please note that required fields are indicated with an asterisk (*).

 

St. Joseph Institute is a leader in treatment for addictions to alcohol & drugs. Our program includes residential, inpatient rehab & detox, and most insurance plans are accepted. We are located between Altoona and State College, in the beautiful mountains of Central Pennsylvania.

Fill out our
Contact Form
or call
(888) 834-5424
to get help NOW!