Overcome NJ

101 Prospect Street, Suite 210
Lakewood, NJ 08701

Who are you seeking support for? *

For myself

For my spouse/partner

For my child

For another family member

For my friend or colleague

What type of addiction or behavior is causing concern right now? *

Alcohol

Substance Abuse

Mental Health

(You may choose more than one)

Has treatment been attempted before? *

This would be the first time

Outpatient

Detox under medical supervision

Residential rehab - Inpatient

Multiple past attempts

Currently in treatment

How urgent does the situation feel right now? *

Immediate help needed (today/ASAP)

Within the next few days

Within the next week

Do you have commercial, Medicaid, or Medicare insurance? *

Example: Medicaid, Medicare, Commercial. We also accept direct payment.

If you aren't presently available, when is the best time to reach you

Example: 5/25 6PM

What is your Zip code? (this helps us know that we are reaching people in our area) *

What is your Full Name? *

Date of birth? *

What is your best phone number? *

What is your best email address? *

I agree to the terms & conditions provided by Overcome NJ, and by providing my phone number, I agree to receive text messages from Overcome NJ.

Once you submit you will be redirected to our website, a member of the team will reach out shortly!