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: 541-687-1110 or fill out our confidential inquiry form and we will contact you.

Name*
First Last
Phone Number*
Email*
Preferred Method of Contact*
- Phone Call
- Email
Where are you located (Optional)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
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
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.
Comments
This field is for validation purposes and should be left unchanged.

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

Call to talk to an admissions counselor confidentially at: 541-687-1110 or fill out our confidential inquiry form and we will contact you.