Tell us about your experience with
For immediate assistance
If you are in an emergency, dial 911. If you need immediate assistance finding mental health or substance use treatment providers, call the SAMHSA National Helpline at 1-800-662-HELP (4357).
We are working to make it easier for people to find treatment across the country. We are testing a new design and welcome your feedback. We’ll use what we learn to improve the site.
Note: We won’t share your information with any other organizations or groups, period. Here’s how we’ll use the information we collect:
Tell us about your experience on this website *
Your answer
Optional: We’re looking for people to participate in a 15-30 minute interview about how they use If you're interested, please fill out the information below. If selected, we’ll contact you to set up a time.
Name (optional)
Your answer
Email address (optional)
Your answer
Phone number (optional)
Your answer
Never submit passwords through Google Forms.
This form was created inside of Report Abuse