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General Questions or Comments

If you would like more information about the programs and services provided by Addiction Services of Thames Valley, please contact us using the form below.

Name

   Mr.  Mrs.  Ms  Miss

Address

City / Town

   

Province

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Telephone

    (area code) + number

Email


How would you like to be contacted? Please choose one of the following options.

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Your Comments:

Section 2:

After reviewing the web site Privacy Policy and Terms of Use Agreement,
I agree to answer the following questions:

 I agree that Addiction Services of Thames Valley (ADSTV) can contact me and have chosen above how I can be reached.

 I understand that when I submit this form my information will be sent virtually via the internet to the intake office at Addiction Services of Thames Valley (ADSTV) and that a staff member from ADSTV will be contacting me by telephone, email or postal mail.

Click the Submit button to forward your information to ADSTV.

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