Project GHB a force of prevention

Addiction Help

It is important that you fill out all fields as completely as possible so that we can help refer you to the best resource.

If you do not feel comfortable submitting this information through the online form, please feel free to contact us.

Entries with "*" are required.

Type of Product being used
* Describe the product, if it is from a packaged product (analog), what is the name and where purchased if known
How long have you been taking it?
How much, and how often?
General Side Effects when taking?
What happens if not taken within a certain time span?
If you have other medical contacts, such as an M.D., may we contact them? If so, please list them
If you've tried an addiction treatment facility but the location didn't have GHB knowledge, please list them
* Information about your circumstances: (the more information you provide, the better we can help)
*Name
*eMail
*Phone
best time to contact?
By submitting this form I understand that Project GHB and associates are not doctors and will not be prescribing medical treatment respectively? Yes I have read and understand the Privacy Statement. Yes
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We have a growing list of treatment facilities, doctors, and ERs that can treat GHB withdrawal. Not all doctors know how to treat it. However, you agree that it is ultimately up to YOU to get help. We respect your privacy. See our Privacy Statement