Share Your Story - Council on Chemical Abuse | Your Bridge to Addiction Resources

First & Last Name*

Age

Email*

Do you live or work in Berks County, PA?*

Yes
No

How has recovery from addiction changed your life? (You may share your personal experience or about a loved one.)

Would you like to remain anonymous?*

Yes
No
No - but use my first name and last name initial

May we contact you for additional information?*

Yes
No

Consent*

By checking the below 'I agree' button, you are authorizing the COUNCIL ON CHEMICAL ABUSE to publish your submission on our webpage www.cocaberks.org.*

CAPTCHA