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Fill this form if you're struggling with an addiction, and we'll get back to you.
Telegram ID (Optional)
Date of Birth
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What do you struggle with
Drugs / Substance Abuse
Tell us briefly how it started (Optional)
How bad is it?
I do this ocassionally
I do this frequently
I can't go a day without doing this
Are you willing to let this go?
Can you fast?
Will you help others when you get free?