Request a call back
It takes about two minutes. Our intake team will call you, usually within one business day. This form is not watched around the clock. In an emergency, call 911. For a mental health or substance use crisis, call or text 988.
Who are you asking about?
*
Myself
Someone I care about
Your name
*
First Name
Last Name
Phone number
*
Format: (000) 000-0000.
Email (optional)
Best time to call
Morning
Afternoon
Any time
Is it OK to leave a voicemail that says we are calling from Fred Brown's Recovery Services?
*
Yes
No, leave only a first name and number
Is it OK to text you?
Yes
No
Gender
*
Male
Female
Transgender
Prefer to discuss by phone
Do you have Medi-Cal through Los Angeles County?
*
Yes
No
Not sure
Are you on probation or parole?
No
Probation
Parole
Prefer to discuss by phone
Have you been a client at Fred Brown's before?
Yes
No
Your relationship to them
*
Do they know you are reaching out?
Yes
No
Not sure
Their first name (optional)
Which program are you asking about?
Residential
Outpatient
Recovery Bridge Housing
Not sure
Anything you'd like us to know before we call? (optional)
Share only what you're comfortable with. We'll go over the details by phone.
Please confirm
*
I understand this form is not for emergencies, and Fred Brown's Recovery Services may call me at the number above.
Request a call
Should be Empty: