Assistance Request Form

Take the first step. We're here to connect you with the support and resources you need.

Hold Harmless Agreement

This Hold Harmless Agreement outlines the terms and conditions under which a user ("User") voluntarily engages with the services provided by HopeLinc.org ("Provider"), particularly in locating and communicating with substance abuse treatment and mental health services.

  1. Acknowledgment of Voluntary Use: User acknowledges that their use of Provider's services is entirely voluntary and comes at no cost to them.
  2. Assumption of Risk: User understands that there are inherent risks involved in seeking and utilizing substance abuse treatment and mental health services. User accepts full responsibility for these risks. User provides a release of information to substance abuse treatment and mental health service providers.
  3. Hold Harmless: User agrees to indemnify and defend Provider against any liabilities, claims, damages, expenses, and losses arising from User's use of the services, including personal injury, property damage, or loss attributable to the services provided by Provider.
  4. No Warranty: Provider does not guarantee the completeness, accuracy, or timeliness of the information provided in its services, and they are provided "as is" without any express or implied warranty.
  5. Limitation of Liability: Provider shall not be liable for any direct, indirect, punitive, incidental, special, or consequential damages arising from or related to the use of its services or the inability to use them.
  6. Modification: Any modifications to this Agreement must be made in writing and signed by both parties.
  7. Governing Law: The Agreement is governed by the laws of the State of Georgia, without regard to its conflict of law provisions.

By using the services provided by Hopelinc.org, the User acknowledges having read, understood, and agreed to the terms and conditions outlined in this Agreement.

Personal Information

Address & Residency

Employment & Program Status

Conditions & History

Medical Information

Government Aid

Additional Information

Your Request

All information is confidential. We'll review your request and reach out to you as soon as possible.

What Happens Next?

1

We Review

Our team carefully reviews your request and identifies the best resources for your situation

2

We Reach Out

We'll contact you to discuss your needs and connect you with appropriate services

3

Get Support

Begin receiving the help and resources you need on your path forward

Need Immediate Help?

If you're in crisis or need immediate support, please reach out to us directly.