Fast Track Admission | First Step Legacy Be

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Meeting

Upon completion of form, Our admission coordinator will contact you within 24 hours.

First Name

Last Name

Email

Phone

Emergency Contact ( By submitting this form I give FSL consent to contact my emergency contact in reference to any treatment information) Please enter the Emergency Contact name and phone number below.

Please check level of care request (A clinical assessment will be conducted during admission to determine level of care) * Required

IOP

OP

Detox Referral

Mental Health Treatment

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Contact Us

4707 C Harford Rd.

Baltimore, MD 21214

(443) 769-2090

Admission@FirstStepLegacy.com

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