Name *

First Name

Last Name

Preferred language *

If other, please note in the message section your preferred language.

English

Español

Other

May we identify ourselves as NDTS when we call? *

Privacy is important to us and for you. If you would like our Care Managers to identify themselves only by their first name, please mark "no" below.

Yes

No

What would you like to contact us about? *

Check one or more

Admissions

Available Services

General Information

Other

What treatment are you seeking? *

Substance Use Disorder

Behavioral Health

For which location are you seeking treatment? *

Berks County

Lehigh Valley

Are you contacting us for: *

Yourself

a Loved One