Bridging the Gap

Bridging the Gap

Contact Form
"I am responsible...

When anyone, anywhere, reaches out for help,

I want the hand of A.A. always to be there.

And for that: I am responsible"

If you have a prooblem with alcohol and are leaving a treatment or detox facility, please fill out this form and you will be contacted by a member of Alcoholics Anonymous. As you know, one of the more "slippery" places in the journey to sobriety is between the door of the facility and the nearest A.A. meeting.

"Bridging the Gap" is a contact program designed to assist you to make the transition from a treatment or detox facility to A.A.

The purpose of "Bridging the Gap" is to supply you with a contact when you get home from the facility. The way it works is, when you are leaving a facility and you want to contact A.A. we will put you in touch with a member who will introduce you to your local Alcohlics Anonymous community.
Name*

First NameLast Name or Initial
Phone Number
Please enter a valid phone number.
Email
example@example.com
Date of Release

MonthDayYear
Date
Name of Facility*
Facility Phone*
Please enter a valid phone number.
City or Town going to*
Date of Arrival in city/town

MonthDayYear
Date
May we contact you prior to release?*

YesNo
Age*
Gender*
Preferred pronouns
Comments
Anything else we need to know?
Should be Empty: