Getting Help Now | Innovo Detox

What is your date of birth?(Required)

Month

Day

Year

Are you over 12 weeks pregnant?(Required)

Yes

Have you had detox treatment before?(Required)

Yes

If you have had detox before, did you experience:(Required)

Withdrawal seizures

Delirium Tremens

Admitted to ER/Hospital in last 3 months

I did not experience any of these symptoms

How would you like to pay for treatment?(Required)

Commercial Health Insurance

Pay Directly

Tricare

Medicare/Medicaid

Are you confident in your ability to pay for treatment?(Required)

Unfortunately, we are unable to accept Medicaid or Medicare as payment for detox treatment services. However, we are able to work on a sliding scale for individuals or families that are in financial hardship or who are having difficulty paying for treatment.

Yes

What is your zip code? (must be a valid zip code in the U.S.)(Required)

Please provide your first name(Required)

Please indicate the substances you are using

Alcohol

Heroin

Fentanyl

Methadone

Suboxone Buprenorphine/naloxone

Clonazolam

Kratom

Marijuana

Benzodiazepines

Xanax

Klonopin

Ativan

Valium

Tranxene

Short-Acting Opioids

Oxycodone

Percocet

Hydrocodone

Norco/Vicodin/Lortab

Morphine IR

Hydromorphone

Dilaudid IR

M30

Long-Acting Opioids

Oxycodone ER

Oxycontin

Oxymorphone

Opana

Morphine ER

MS Contin

Stimulants

Ritalin

Dexedrine

Adderall

Vyvanase

Atomoxetine

Provigil

Cocaine

Methamphetamine

If you would like an estimated length of stay, please provide:(Required)

Phone(Required)

Great news! Your answers indicate we can help you recover at Innovo Detox

Please choose the best way for our admissions team to connect with you:(Required)

Call me

Text me

Email me

Or contact our admissions team directly by calling 717.619.3260

Getting Help

Please complete the form below

Great news! Your answers indicate we can help you recover at Innovo Detox