Opioid Survey

1. Do you live in Kansas?*

Yes
No

Our services are only available in Kansas.

2. Do you currently use opiates?*

Yes
No

Has it caused problems?*

Yes
No

Your willingness to take this quiz might be an indicator you believe you have an opioid problem. We have resources that can help with opioid abuse. Fill out the form on the left, enter your email below, or call our 24/7 Helpline at 785-825-6224.

3. Are you interested in talking with a counselor about treatment options?*

Yes
No

Treatments are available here:

1805 South Ohio Street
Salina, Kansas 67401
Phone: 785-825-6224
Click here for more information about all our locations across Kansas.

You were willing to complete this assessment - when you are ready, CKF Addiction Treatment has resources that can help. Fill out the form on the left, enter your email below, or call our 24/7 Helpline at 785-825-6224.

4. Do you have insurance?*

Yes
No

We want to help you find treatment options. You are not obligated to fill out the information below, but it will help us find resources that available to you.

Name

First Last

Phone

Email

This field is for validation purposes and should be left unchanged.

Help | Hope | Healing

Our Opioid Survey