The professionals at LifeLine Treatment Center are here for you 24/7.

If you feel that you are a danger to yourself, please pause filling out this form and contact the National Suicide Prevention Hotline at 800-273-8255.

Please note that by leaving your contact information in the space provided, you consent to allow LifeLine Treatment Center to use this information to contact you. Any information provided will remain confidential. Please note that by choosing to not leave your information, the staff at LifeLine Treatment Center will not contact you.