Adult Services Get Help Form

Get Help Form

Opioid Use Treatment, Mental Health, Alcohol & Other Drug Treatment, and other Programs for Adults, Youth and Families.
Remember, if you are experiencing a medical or other emergency, call 911 immediately.

If you are in crisis and wish to reach the King County Crisis Line, please call 206-461-3222 or 1-866-4CRISIS (427-4747).

In Snohomish County, please call 2-1-1 or the Care Crisis Line at 1-800-584-3578.
What Is Your Name? *

First Name Last Name
What Is Your Phone Number? *

Area Code Phone Number
What Is Your Email? *
example@example.com
What Is Your Age? *
Are You Pregnant?

Yes No
Pregnant SF
hidden - for integration use only
Are You Inquiring For a Youth Under the Age of 18 Who Needs Service? *

Yes No
Please Select the Services You are Interested In:
(choose one or more)
Opioid Use Treatment
Mental Health
Alcohol / Drug Treatment
Youth SUD Treatment
Youth Mental Health
Youth & Families Services
Opioid True/False
integration
Mental Health True/False
integration
Alcohol Drug TF
integration
Youth SUD TF
integration
Youth Mental Health TF
integration
Youth & Family Services TF
integration
Court-Ordered TF
integration
Are You Seeking a Court-Ordered Assessment? *

Yes No
What Is Your Health Insurance? *
What Is Your Health Insurance Plan? *
Please Enter Your Insurance Plan Here: *
Which City or Seattle Neighborhood Do You Live In? *
What Is Your Zip Code?
Is There Anything Else You'd Like Us to Know?

0/250
You may receive a call from Restricted, Unknown, Anonymous or another form of blocked number. This is our staff reaching out to you in a way that preserves your privacy as well as our patient’s. Please answer this call so we can better help you connect to care or assist you with your inquiry.

By providing the information in the contact form above and submitting this form electronically, I am authorizing Therapeutic Health Services to communicate with me via phone call, text message, and email.
Lead Type
integration
Company
integration
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Get Help Form

By providing the information in the contact form above and submitting this form electronically, I am authorizing Therapeutic Health Services to communicate with me via phone call, text message, and email.