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To help us get started in understanding your needs please complete the form below.  This information will be forwarded to our admission counselor who will then contact you to discuss the information and conduct a basic screening.  The information provided is confidential and protected by federal law.  We have security protocols in place to protect your information.  If you are not comfortable submitting the form, use the "GET STARTED" here to schedule a telephone or telehealth screening directly. ​

White Sheet
Submit an Information Request to Denison
Is thi cell phone numbr?
Can we leave voicemail?
Is this yours or someone else's?
Can we contact you by text?
Have you taken (prescribedor non-prescribed) methadone, buprenorphine (suboxone), naltrexone (vivitrol) in te lst 30 days?
Do we hae permisson to leave a mesaage?
Preferred contact method:
Can we contact you via telehealth (video cnferencing)?

Thanks for sharing! We always strive to improve.

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