Lakeland Centres Atlanta Online Inquiry Form
Your journey to recovery starts here! Get more information on how we can help start your admission process today?
Please contact us using this online form and someone will attempt to contact you within 24 hours.
All information is strictly confidential and is sent electronically for the sole purpose to assess appropriateness for treatment. Please complete the information below.
Thank you for submitting your information. We look forward to serving you and we will contact you soon to discuss your needs and the services that we can provide.
Phone or Contact Number:
Do you need treatment for opioid addiction (heroin or pain medication)?
Have you ever been in methadone treatment before?
What city & state do you reside in?
Do you have state identification?
Do you need an alcohol and drug evaluation?
How did you hear about us?
Do Not Fill This Out