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7632 Pool Station Rd, Angels Camp, CA 95222-9620

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Full Name

Email

Phone

Person That Needs Help

How Old is the Person?

Has There Been Any Previous Treatments?

Do You Have Private Insurance?

Please List Active Drug Use - Check All That Apply

Cocaine

Crack

Heroin

Opioids

Methamphetamine

Ecstacy

GHB

Inhalents

Ketamine

Marijuana

Prescription Drugs

Other

Please describe any personal/family problems the person has

Please describe any diagnosed medical condition or mental disorder

Please describe any erratic behavior

Please tell us anything else you feel may be important

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ADDICTION ASSESSMENT

Licensed & Certified by the California State

Quick Links

Alcohol Addiction
Heroin Addiction
Opiate Addiction
Ecstasy Addiction
Detoxification
Substance Abuse Treatment
Buprenorphine Treatment
Alcohol Addiction Treatment

Cocaine Addiction
Cannibis Addiction
Synthetic Addiction
Inhalant Addiction
Relapse Prevention
Hydrocodone Addiction
Prescription Addiction
Methamphetamine Addiction

Contact Information

Lic# 050002AN Exp 09/23

7632 Pool Station Rd.
Angels Camp, C A 95222-9620

changing@changingechoes.com

Mon - Sun Open 24 Hours

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