Confidential Inquiry form

Serenity Lane is an addiction recovery treatment center with locations throughout Oregon. We offer a variety of treatment programs to help you or your loved one dealing with substance abuse addictions. Contact us using our confidential inquiry form to get the help you need.

Call to talk to an admissions counselor confidentially at: 800-543-9905 or fill out our confidential inquiry form and we will contact you.

If you are experiencing a mental health crisis, please call 988.

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This field is for validation purposes and should be left unchanged.
Name*
First Last
Phone Number*
Email*
Where are you located? (Optional)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Have you been a patient with us before?
- Yes
- No
- Not sure/other
How can we help?*
By providing insurance information we will be able to respond more efficiently to your inquiry. These fields are optional.
Patient's Insurance Company
Patient's Group Number
Patient's Member Number
Patient's Date of Birth
Who Referred You To Us? *
Consent
I agree to receive texts from Serenity Lane at the phone number provided above. I understand that data rates may apply. Reply STOP to opt out
By submitting this information I signify the information presented herein is true and authorize Serenity Lane admissions staff to review the information submitted and contact me.
Only click SUBMIT one time to avoid a double submission. Thank you for your patience as it can take some time to submit. You will receive an automated email confirmation when it goes through.

We do not share this information with any organizations outside of Serenity Lane.

Privacy Practices

Call to talk to an admissions counselor confidentially at: 800-543-9905 or fill out our confidential inquiry form and we will contact you.