Placement Services Form for Treatment and Rehabilitation

There are no charges associated with our placement services.

  • Your relationship to this person

  • Personal data of individual needing help

  • Financial Resources

  • The Way Out is dedicated to getting you the most cost-effective treatment available for your needs – we have pre-arranged financial agreements with many service providers. This allows us to get the help you want and need at a lower cost. Most form submissions will be responded to within minutes. Please provide detailed and accurate information for best results.
  • Please be advised that filling out this form, accessing this website as well as email and call inquiries regarding treatment, and or potential treatment, does not constitute the formation of a clinical and or professional relationship.