Contact information: Fill out the Form below and we will Contact you ASAP.  Your Name, First & Last  Your Phone Number and area code My e-mail address is: Best time to call is, am  pm: Pacific-time, Mountain-time, Central-time, Eastern-time: A). Medical History: Does the individual have any medical problems? (Please describe)       Is the individual currently taking any medications?  yes  no      If yes, please specify what and length of use:       B). Legal History: Does the individual have a valid drivers license?  yes  no Has the individual ever been arrested? (If so, for what)       Are any crimes actively being committed to support, or as a result of the alcoholism or addiction?       C). Substance Abuse History: At what age did the individual start using the substance?:       Different drugs used:       Method of use:          Oral     IV-(Inject)     inhale(Smoke)     nasal(Snort)     Other Past treatment attempts (What rehab, when, results:        D). General Contact Information:  Your Relation to the Alcoholic/Addict: Alcoholics/Addicts Name: City and State in which they live: Can they travel outside of this area for treatment?  yes  no How old is the addict ? Current drug (s) their using:       Question/Comment/How can we help you: All content on this web site is Copyright © 2003 - 2014  Texas Drug Rehab Helpline          Texas Crystal Meth problem  Methamphetamine addiction in Texas is becoming common place in most communities in Texas. more families than ever before are affected by this. 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