Set Up An Appointment

Please contact us if you need immediate help, are a family member or friend seeking additional information about The FreedomFromAlcoholtm Method, wish to purchase any of our products or services, or are seeking independent consultation.

You can also complete the information in the form below and click the "Submit" button to return it to us. You can also print out the form, complete it and fax it to (240) 526-8207 or send it to us at the address below.

The brief questions below are designed to help us discuss your situation with you based on what you're experiencing today. If you do not feel comfortable completing any of the questions regarding your drinking, please leave them blank.

Contact Information

First Name *
Last Name *
E-mail address *
Street Address
City
State
Phone	.ex:
Phone Type
If you would like a return call:
Best day to call
Best time to call
Best time to call	AM PM

Background Information

How long have you been drinking?*
How often do you drink?*
How long has it been that you’ve felt your drinking might be a problem?*
Have you taken the alcohol screening test?*	Yes No
If so, what were the results?*
Is there any specific information I can provide to you, or questions I can answer for you in our appointment? If so, please indicate here
	* required field All client information is kept strictly confidential. Read our full Privacy Policy

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