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Do you qualify for Suboxone?
Answer a few quick questions to find out if suboxone could be right for you. This form is not to be used in place of medical advice from a doctor.
14Questions
  • 1
    Select the option that applies most to you
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  • 2
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  • 4
    If you do not have medical insurance but qualify for it, our team may still be able to help.
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  • 5
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  • 6
    If you do not currently use opiates, please select "Not applicable"
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  • 7
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  • 9

    It sounds like Suboxone could be a good fit for your recovery treatment!

    A member of our patient care team will be in contact with you soon to schedule your first appointment. 

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  • 10
    We need just a little bit more information
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  • 11
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  • 13
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  • 14

    Suboxone might not be the best fit for your recovery treatment, but there are other options! 

    A member of our patient care team will reach out to you soon to answer questions and provide information! 

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