Where do you live?

This helps us pair you with a licensed clinician in your state.

🔓 For your security

Were you referred by another healthcare provider?

How would you describe your opioid use?

How would you describe your relationship with Treatment?

Have you used a substance in the last week?

Is your treatment center currently meeting your needs?

How many days has it been since you last used substances?

How long have you currently been in treatment?

Do you feel currently take MAT?

How long have you been using opioids (not including Suboxone) or Alchol?

How frequently are you using opioids?

Are you using heroin or fentanyl on a regular basis?

In the past two months, have you had difficulty with any of the following?

Are you insured?

Why do you want to join empower?

Your "why" is the biggest reason you're here. It can help carry you through challenging times. Take your time to jot it down below.

Examples of a "why"

How soon are you interested in starting treatment?

After your welcome call, we'll schedule your first visit with a licensed clinician. No charge if we're not a fit.

Thanks, we've got your number

We'll text you when we launch in Alaska

Sorry, we aren't a good fit.

Currently, we only treat opioid use disorder

Here are some other resources that may help.

Looking to help a friend?

SAMHSA's National Helpline
1-800-662-HELP

Free or reduced cost services
Aunt Bertha

Suicide Prevention Hotline
1-800-273-TALK

SVeteran's Crisis Line
1-800-273-TALK

National Domestic Violence Hotline
1-800-799-SAFE