Alcohol Use Contact Form

If you have a question, would like more information, or have another concern, please complete the form below. Please note that the form submissions are not monitored 24/7. IMPORTANT: If you need immediate assistance, support is available through Live Chat, by calling (855) 581-8111, or texting (855) 895-8398.

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You have taken an important step by filling out this confidential form and by checking the box below you agree to have a problem drinking professional contact you.

I agree to have a Your Life Iowa counselor contact me.