We’re Here To Help

 

Please fill out the form below and we’ll be in touch with you as soon as we can.

Drug Use

Living Arrangements

Payment

We're Almost Done!

  • Step 1
  • Step 2
  • Step 3
  • Step 4
  • Step 5

Tell us a little about yourself.

My name is

Date of Birth (DOB)

What best describes your current situation?

Describe what you or your loved one is struggling with right now.

What type of drugs are you or your loved one using? (Please click all that applies)

Required

What other type of drug?

Frequency

What is you (or your loved one’s) current living situation?

Who do you (or your loved one) currently live with?

Do you (or your loved one) live with someone/people who use or abuse substances (illegal or legal)?

Marital Status

Children

Employment

Benefits Check

Do you or your loved one have insurance?

Insurance Carrier:

Insurance Type:

Group Number:

Policy Number:

Please enter your contact information.

Full Name

Email

Phone Number

 

 

 

 

Covid-19 Update
We're Committed to Your Safety

As leaders in behavioral healthcare, Bright Future Recovery is taking every measure to protect our staff and patients.  All of our treatment programs will continue to remain open, but we will adjust our programming based on the information provided by the Centers for Disease Control and Prevention (CDC), state and local authorities, and the Joint Commission to protect the health and safety of our patients, staff, and our community. 

Thank you for your cooperation and for understanding. If you have any questions or need assistance with our program, please contact us for more information.