If you are unable to call Madison Comprehensive Treatment Centers, please use the below form to submit a confidential message to our Admissions staff. We will get back to you as soon as possible.
If you are in a state of crisis or need immediate help for any reason, please pause filling out this form and call 911.
If you feel that you are a danger to yourself, please pause filling out this form and contact the National Suicide Prevention Lifeline at 1-800-273-8255 or 911.
If you are unable to call Madison Comprehensive Treatment Centers at (855) 215-4783 please use the form provided below to submit a confidential message to our admissions staff. We will respond as soon as possible.
Please note that by leaving your contact information in the space provided, you consent to allow Madison Comprehensive Treatment Centers to use this information to contact you. Any information provided will remain confidential. Please note that by choosing to not leave your information, the staff at Madison Comprehensive Treatment Centers will not contact you.
Disclaimer: Madison Comprehensive Treatment Centers disclaims any liability, loss, or risk sustained directly or indirectly as a consequence of any actions you take with this form.