Substance Abuse and Behavioral/Mental Health – Request An Appointment

Your Name (required)

Your Phone Number (required)

Your Email

When is the best time to call you? (required)

Who is the appointment for? (required)
—Please choose an option—ChildAdolescentVeteranAdult – Someone ElseAdult – Myself

Preferred Day of Appointment
—Please choose an option—MondayTuesdayWednesdayThursdayFriday

Preferred Time of Appointment
—Please choose an option—Morning (8am – 12pm)Afternoon (12pm – 5pm)Evening (5pm – 8pm)

What County do you live in?
—Please choose an option—EdgecombeGreeneLenoirNashPittWayneWilson

Do you need FREE Transportation to and from your Assessment/Treatment?
—Please choose an option—YesNo

What insurance do you have?
—Please choose an option—No InsuranceMedicaidTriCareCignaAetnaBlue Cross Blue ShieldOther

Please describe the reason for this appointment. (required)

How did you hear about us? (required)
—Please choose an option—LawyerProbation OfficerDept. of Social ServicesNC Dept. HHS Provider DatabasePOWER 95.5 FMBig DAWG 98.5 FMRock City 99.3 FMFacebookFriend or FamilyGoogle SearchReferralOther