Teen Intervene Enrollment Request
Teen Intervene is a FREE early intervention program offered by Community Behavioral Health for 12-19 year olds with mild-moderate substance use disorder, risky drug behaviors, or even curiosity about drug use.  

Enrolling in Teen Intervene does not mean you are a patient of Community Behavioral Health and there is no long term commitment to care beyond the education and discussion sessions.

Please fill out the following form to enroll in Teen Intervene. After we receive your information, you will be contacted by a staff member to set up an appointment.
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Email *
What is the full name of the teenager requesting services? *
What is the name of the parent or guardian who would like to attend a separate session? *
What is the teenager's date of birth? *
What is the teenager's gender? *
What is the teenager's race? *
What is the best contact number to reach the teenager and guardian to schedule sessions? *
Would your teenager be able to attend the session if it was held in a group with other teenagers? Parent sessions are held individually but the teenager may join if they wish. *
Would you prefer in person or virtual sessions? *
What is the zip code of the place where you live? *
If applicable, what is the name of the place where you attend school or most recently attended school? *
Thank You!
If you or your teenager are concerned there is an emergency, please go to your nearest emergency room or dial 911. If you feel you may need more intensive treatment beyond an early intervention program, go to https://www.communitybehavioralhealth.net/intake and register as a new patient.
A copy of your responses will be emailed to the address you provided.
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