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Hamilton Recovery Center Assessment

Your Name:
Zip Code:
Phone Number:

Current drug(s) they're using:
Zip Code in which they live:
Check if able to travel outside of this area code for treatment?:

Please fill in other patient details regarding addict:

How did you find us? (please be specific):

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The first step to starting treatment for drug or alcohol addiction is to be evaluated by a substance abuse professional. The purpose of the assessment is to get a better understand of your substance abuse problem and to evaluate what level of treatment will best suit your needs.

Please fill out the form to receive a call from one of our qualified addiction specialist.

 

All information that
you provide in this
assessment is confidential.

 

  Hamilton Recovery Center
2117 Route 33 Suite 1
Hamilton, NJ 08619
  Division of Palm Partners

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