Let’s get started with addiction treatment for the whole you

Name

Phone Number

When is the best time to contact you? (For example, “right now” or “tonight after 6 p.m.”)

How should we get in touch? How should we get in touch? Call or text Call only Text only

Have you used Suboxone or Buprenorphine before? Have you used Suboxone or Buprenorphine before? Yes, I am or was previously prescribed it Yes, I obtained it on the street or otherwise No

Do you have health insurance? Do you have health insurance? Yes, I have Medicaid (NH Healthy Families, Amerihealth Caritas, Well Sense, VT Medicaid or MaineCare) Yes, I have Medicare or Medicare Advantage Yes, I have insurance (Anthem, Blue Cross, Optum, Harvard Pilgrim, Aetna, Humana) No, but I would like help getting Medicaid, Medicare, or an AHA plan No, but I would like to understand sliding-scale, grant-funded, or self-pay options I don't know