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Country US AF AX AL DZ AD AO AI AQ AG AR AM AW AU AT AZ BS BH BD BB BY BE BZ BJ BM BT BO BQ BA BW BV BR IO BN BG BF BI KH CM CA CV KY CF TD CL CN CX CC CO KM CG CD CK CR CI HR CU CW CY CZ DK DJ DM DO EC EG SV GQ ER EE ET FK FO FJ FI FR GF PF TF GA GM GE DE GH GI GR GL GD GP GT GG GN GW GY HT HM VA HN HU IS IN ID IR IQ IE IM IL IT JM JP JE JO KZ KE KI KP KR KW KG LA LV LB LS LR LY LI LT LU MO MK MG MW MY MV ML MT MQ MR MU YT MX MD MC MN ME MS MA MZ MM NA NR NP NL NC NZ NI NE NG NU NF NO OM PK PS PA PG PY PE PH PN PL PT QA RE RO RU RW BL SH KN LC MF PM VC WS SM ST SA SN RS SC SL SG SX SK SI SB SO ZA GS SS ES LK SD SR SJ SZ SE CH SY TW TJ TZ TH TL TG TK TO TT TN TR TM TC TV UG UA AE GB UY UZ VU VE VN VG WF EH YE ZM ZW

State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Best time to call? (Central U.S. Time) 8 a.m. - 10 a.m.10 a.m. - NoonNoon - 2 p.m.2 p.m. - 4 p.m.

Were you referred to the Connection program? Yes No

Referral Source Hazelden Betty Ford addiction or mental health counselorHazelden Betty Ford family programOther addiction or mental health counselorIndependent therapistAttorney or court officialEducator or school administratorOther

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