Using drugs can affect your health and some medications you may take. Please help us provide you with the best medical care by answering the questions below.
*By submitting this form, I agree to be contacted by De Paul Treatment Centers at the phone number and email provided above. I authorize De Paul to leave messages for me including De Paul’s name, caller’s name and contact information. I understand that in so doing, De Paul cannot protect this information and that others with access to my electronic equipment (e.g., phone, answering machine; cell phone or computer) could have access to this message. We do not share this information with any outside organizations.