MY INFORMATION IS ALREADY LISTED, BUT NEEDS TO BE CHANGED. PLEASE UPDATE MY LISTING TO REFLECT THE NEW INFORMATION BELOW

Your Name:
(this is for our records. It will NOT appear
in the listing unless specified in the next field):

The name of the group, treatment facility,
hospital, support group, doctor, therapist or
dietitian as it should appear:

Certification/Degree (if it applies) that
should appear in the listing:

Street Address:

City and State/Province:

Zip or Postal Code:

Country:

Phone Number 1:

Phone Number 2:

E-Mail Address:

Do you want your e-mail address to appear in your listing:
(it is not required, but we strongly recommend it):
NO               YES

If you have a website and would like a link to it
with your listing, include the URL/address here:

Are you interested in a Priority Placement Listing?
Priority placement listings are similar to priority results at Google. Your normal listing will appear and an additional listing will appear near the top along the right-hand side of the page (highlighted in pink). This will display your facility name, website address or e-mail address, phone number and a 1-line description. The fee for this is $50.00 per month buyable in six-month blocks of time. If you select this option your normal placement listing will be placed on the site and we will contact you with further information about the availability of a priority listing for your location.
NO               YES

Description of services --
Feel free to include as much or as little
information as you'd like:

PLEASE READ:
THERE IS NO REQUIRED FEE FOR THIS.
Because it costs money to maintain the website and push forward in our efforts to raise awareness, we ask that you consider making a one-time donation in exchange for this service. Please keep in mind that we are not a big organization with lots of money or man-power... just a husband and wife trying to make a difference. We feel that a fair amount is between $15 and $30, which would be in exchange for the information about your services that appear in the Treatment Finder. Your ad can remain here as long as you want, and you will never be asked to pay anything to house it or maintain it (should it ever required changes). The money we receive from you will be put right back into our projects of raising awareness, including the website, the CD, the CD-Rom, etc.
Priority Placement -- For a monthly fee, we also now offer the opportunity to guarantee your placement (when available) as one of the top listings for your state -- if you are interested, please indicate in the form above under the question about priority placement. We will contact you by e-mail with the details.