Bristol OTP - Waitlist Lead Form

Join the Waitlist!

Join our waitlist today to get early updates and priority scheduling for methadone treatment at Cedar Recovery Bristol, VA.
Please complete the information below and a member of our team will reach out to you shortly.
Name*
Contact Number*
Email*
Date of Birth*

MonthDayYear
Date
Insurance *
Are you pregnant?*

YesNoNot applicable
Are you transferring from another treatment program?*

YesNo
How did you hear about us?*

Family/FriendInternet SearchGoogle AdSocial MediaHealthcare ProviderOther Addiction Treatment ProgramOther (please explain below)
If Other, please explain how you heard about us:
By providing a telephone number and submitting this form you are consenting to be contacted by SMS text message. Message & data rates may apply. You can reply STOP to opt-out of further messaging.
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Join the Waitlist!