Treatment Application

top of page

Home
Get Help
About Us
Blog
Blog
Donate
Current Initiatives

We are here to walk with you through the process of accessing care. This application is for individuals seeking assistance with navigating treatment options or financial support for the cost of care. Please provide the details below, and a member of our team will follow up personally to discuss your situation.

Basic Information

First name *

Last name*

Phone*

City & State*

Preferred method of contact

Who is this for? (myself, loved one etc.)*

Substance Use Details:

Primary substance(s) of concern:

How long has this been an issue?

Are you/they currently using?

Yes

Tell us what’s going on and how we can help. You can share as much or as little as you’re comfortable with.*

Treatment History

Have you/they been to treatment before? If so which facility?

Barriers to Treatment (all that apply)

Cost

No insurance

Transportation

Fear/anxiety

Family/work responsibilities

Single mom

Insurance:

Do you have insurance? (Yes/No/Not sure) If yes, provider name *

Have you experienced any recent changes that may affect your insurance coverage? (Select all that apply)

Recently moved to a different state

Recently released from a facility (hospital, treatment center, or correctional facility)

Recently lost or gained insurance

Insurance inactive or pending

Not sure

None of the above

Consent

understand that submission does not guarantee assistance and support is based on availability

I confirm the information provided is accurate to the best of my knowledge

Asheville, NC
thewaythroughproject@gmail.com

bottom of page