Request an Appointment

appointment request form

Request an Appointment

Thank you for your interest in Freedom House Recovery Center. We’re here to support you. Please complete this form, and a member of our team will contact you within two (2) business days to answer any questions or to schedule your appointment.

If you are experiencing a life-threatening emergency, call 911 or proceed to the nearest emergency department immediately. If you are having a mental health or substance use crisis, call our Facility-Based Crisis or our Mobile Crisis team now.

For assistance in making an appointment or to determine how Freedom House can help you, contact your local clinic during business hours. Or, use the request an appointment form below, and a Freedom House representative will contact you within two (2) business days.

If you are contacting us from a Hospital or Crisis Unit, please call (833) 800-1505 during normal business hours.

Select a Location

Some services are only offered at specific locations, but our team will help ensure you get connected to the appropriate care.

Name of the Client to be Seen

Client Age

Please Indicate Your Relationship to the Client

the (optional) Guardian)

Email Where the Client (or Guardian) Can be Reached

Best Contact Phone Number for the Client (or Guardian)

Preferred Method of Contact

New or Returning Client?

Special Instructions (optional)

Please do not include personal or sensitive medical information in this form.

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