Ontario Drug Rehab

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Contact Ontario Drug Rehab

Thank you for your interest in our free drug and alcohol rehab referral program in Ontario. Please fill out this information form completely so that we may better address your individual rehab needs. You may also contact us directly
TOLL FREE 1-888-391-9295

All information collected is held in the strictest confidence.
Ontario Drug Rehab will assist you in locating a qualified and professional drug or alcohol rehabilitation facility to achieve complete rehabilitation. One of our Rehab Placement Specialists will call you back at your convenience.

Your Name:

Your Phone:

Your Email:

Best Time To Call You:

City/Town:

Province:

Addicts Name:

Your Relationship to Addict:

His/Her Drug(s) of Choice:

Is the addict currently on or have they ever been on any prescribed medication of a mood altering or Narcotic nature?

Has the addict ever received treatment for their addiction?

If yes, what kind of treatment? Did they complete the treatment?

Has the addict ever received any treatment by a Psychiatrist, Psychologist or been Diagnosed with a mental illness?

Other specific health requirements which could affect recovery or treatment:

Additional Information:

Ontario Drug and Alcohol Rehab is here to help you. Ontario Drug Rehab has been developed to give the addict a solid foundation when searching for help or treatment with their drug or alcohol addiction. We will assist you in locating a qualified and professional drug or alcohol rehabilitation facility to achieve complete rehabilitation.

Any and all obstacles can be overcome by believing in one thing ...yourself.

Please feel free to contact us and one of our Rehab Placement Specialists will call you back at your convenience.

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