Curt Maddon, CIP

Addiction & Mental Health Professional

Certified Intervention Professional
(505) 900-4434 (Voice or Text)
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Secure Online Assessment

This form is fully encrypted using the latest security protocols for transmission. Once received by Curt’s staff, all information is strictly protected, and will not be released to anyone without permission to do so. The information collected in this form is used to determine the very best of care for your family.

Privacy Assured:

  • Loved One Information

  • MedicationCurrent RX#DosageReasonStart/EndPhysician 
  • WhereWhenWhyCompleted? 
  • Your Information

  • NameAgeRelationshipCell PhoneEmail 
  • Insurance Information

    (used for referral to treatment)
NOTE: Curt Maddon does not provide therapy, treatment, or medical services. Needs for any of these services are referred to individuals and/or facilities specializing in the appropriate level of care. Curt Maddon, and associated brands, offers consulting services and therefore any recommendation given does not replace the advice of therapists, treatment providers or medical professionals.