Do you have a problem(s) with drugs, alcohol, sex, or dependence on other people? Do you feel lost and alone? Is your world coming apart around you and you feel helpless? If you are a troubled teen who is seeking help, please do not hesitate to fill out the form below with an explanation of your troubles. By checking the box indicating you are a troubled teen, we will consider your “message” as high priority and will do our best to respond quickly. We Want To Help You! And be assured All information you send is confidential and will not be given to anyone without your consent. You only need give your Name and e-mail address or phone number so we may contact you.

Goshen appreciates and cherishes the input that is given by everyone. Please feel free to send any comments, questions or suggestions you many have. We will respond back to you as soon as possible.

Name:
Address:
City:
State/Province:
Zip/Postal Code:
Phone:
Email:

Are You a Troubled Teen That Needs Help? YES    NO If yes, please describe what you need help with:	Comments, Suggestions or Questions