About
About Us
What We Treat
Does Your Loved One Need Help?
Why Choose Us?
Our Program Works
Meet Our Leadership Team
See our Rehab Center and Grounds
Blog
CALL US AT 336-553-6596 TO CONNECT WITH AN ADMISSIONS COUNSELOR NOW
Treatment
Treatment Options
What We Treat
Medically Managed Detox
Residential Drug and Alcohol Recovery Program
Women’s Residential Treatment
Men’s Residential Treatment
Residential Treatment for Young Adults
For Professionals
Extended Treatment
Family Programs
Outpatient Services
Connect with us
Admissions
How Much Will Treatment Cost?
What Can I Expect?
What Should I Bring
Admissions Inquiry Form
Insurance Verification Form
Your Health & Safety Is Our Top Priority
Pay Your Bill
CALL US AT 336-553-6596 TO CONNECT WITH AN ADMISSIONS COUNSELOR NOW
Alumni
Surviving the Bermuda Triangle
Continuing Care After Treatment
The Gateway Newsletter
Online Resources
Alumni 101
Hall Mall
More Alumni Events
Education
Careers
Contact
DONATE
Admissions
(336) 553-6596
Office
(336) 621-3381
About
About Us
What We Treat
Does Your Loved One Need Help?
Why Choose Us?
Our Program Works
Meet Our Leadership Team
See our Rehab Center and Grounds
Blog
CALL US AT 336-553-6596 TO CONNECT WITH AN ADMISSIONS COUNSELOR NOW
Treatment
Treatment Options
What We Treat
Medically Managed Detox
Residential Drug and Alcohol Recovery Program
Women’s Residential Treatment
Men’s Residential Treatment
Residential Treatment for Young Adults
For Professionals
Extended Treatment
Family Programs
Outpatient Services
Connect with us
Admissions
How Much Will Treatment Cost?
What Can I Expect?
What Should I Bring
Admissions Inquiry Form
Insurance Verification Form
Your Health & Safety Is Our Top Priority
Pay Your Bill
CALL US AT 336-553-6596 TO CONNECT WITH AN ADMISSIONS COUNSELOR NOW
Alumni
Surviving the Bermuda Triangle
Continuing Care After Treatment
The Gateway Newsletter
Online Resources
Alumni 101
Hall Mall
More Alumni Events
Education
Careers
Contact
DONATE
We can help. Call us at (336) 621-3381
Fellowship Hall
» Four-Day Family Program Payments
Family Therapy Program Payments
"
*
" indicates required fields
One family member is able to attend the
four-day
Family Program at no additional cost. Each additional family member must pay the fee listed below.
Family Therapy Program - additional family members
Quantity
Price:
$400.00
Quantity
Name of family member or friend in treatment
(This information will be kept confidential.)
First
Last
Names of all family members attending the program
*
Payment Information
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone Number
*
Email
*
Total
Terms and Conditions
*
Refunds for the Family Program and Early Recovery Group are non refundable.
I understand
Credit Card
Card Details
Cardholder Name
Email
This field is for validation purposes and should be left unchanged.
Δ
CONNECT WITH US
Our Admissions Staff Is Here to Help
Not sure if you or someone you love needs help? Call our Admissions Staff who can help you assess the next step at
336-553-6596
.
"
*
" indicates required fields
Your Name
*
Email
*
Phone
*
Comments
Name
This field is for validation purposes and should be left unchanged.
Δ