Mothers Against Addiction (MAA) One‑on‑One Support – Participant Intake Form
Please fill out each section before your first meeting. Your answers are private and help us connect you with the right helper. If a question feels uncomfortable, you may skip it. If you are in a crisis now, please call 911 (U.S.) or 988, or your local emergency number.
Your answers are confidential. They will be viewed only by Mothers Against Addiction leadership and the support person matched to you. Thank you for trusting us with your story.
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