First Steps Questionnaire - Addiction Rehab Toronto

First Steps to Getting Help

At Addiction Rehab Toronto, we appreciate you taking the time to help us better understand your situation.

Treatment for:*

Myself

Loved one

Age

Gender

Male

Female

Other

Have you sought treatment in the past?

Yes

No

Do you think you are financially secure?

Yes

No

Name

Email*

Phone*

Areas of Concern

Additional Information

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