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Service Request Form

Get the Support You Need

Fill out the form below, and our team will get back to you promptly.

First Name

Middle Name

Last Name

Date of Birth

Phone Number

Email Address

Service Selection

Which service are you interested in? (Select all that apply):

Chemical Health Assessment

Mental Health Assessment

Housing Resources

Crisis Intervention

On-site/Mobile Chemical Health Assessment

Weekly All Recovery Meetings

Harm Reduction Kits and Education

Community Violence Education

Peer-to-Peer Support Services

24-Hour Crisis Hotline

Details About Your Request

Availability

What is your preferred method of contact?

Phone

Email

What are the best times to reach you?

Morning (9:00 AM – 12:00 PM)

Afternoon (12:00 PM – 5:00 PM)

Evening (5:00 PM – 8:00 PM)

Additional Support Needs (Optional)

Do you require transportation assistance for services?

Yes

No

Are you currently working with any other organizations for support?

Yes

No

please specify:

Consent and Privacy Agreement

I consent to AASS contacting me regarding the services I’ve selected and understand my information will remain confidential.

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Contact us

BLOOMINGTON OFFICE

9333 Nesbit Road, Bloomington, Minnesota 55437

ST. PAUL OFFICE

285 North Dale Street, Suite 100, St. Paul, MN 55103

[email protected]
(612) 306-3416

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afamsurvivors

Join us for a community panel discussion on effect

Join us for a community panel discussion on effective treatment for addiction. Panelists include primary care providers and persons with lived experiences with substance use. Community input is encouraged!

We invite Black communities in South Minneapolis,

We invite Black communities in South Minneapolis, especially Black business owners and caretakers at George Floyd Square to attend the Black Healing for Us by Us event with @chefellowship on Saturday Nov 9th 1-4 pm at 3736 Chicago Ave. We will be tabling to provide harm reduction resources and discuss ways we can support recovery in the Black community! The event will also provide food, art activists, a multi-generational conversation on Black healing, massage therapists, and a community portrait!

Halloween harm reduction ✅ Our first collaborati

Halloween harm reduction ✅ Our first collaboration at @umnmedschool with @whitecoats4blacklives was a success! Thank you to all the volunteers and students who received harm reduction resources to keep themselves and their friends safe!

Instagram post 18033345491072673

Instagram post 18033345491072673

Meet our Team at African American Survivor Service

Meet our Team at African American Survivor Services: Grant Kelly!

#Harmreduction
#Harmreductionsaveslives
#Harmreductionworks
#Harmreductionishealthcare
#Addiction
#Addictionrecovery
#Addictionawareness
#Substanceusedisorder
#Recovery
#Wedorecover
#Blackharmreduction
#Mobilehealthreduction
#Mobile health
#Publichealth
#Opioidcrisis
#Overdoseprevention
#Msp
#Minneapolis
#Mpls

Meet our Team at African American Survivor Service

Meet our Team at African American Survivor Services: Kenneth B. Jackson!

#Harmreduction
#Harmreductionsaveslives
#Harmreductionworks
#Harmreductionishealthcare
#Addiction
#Addictionrecovery
#Addictionawareness
#Substanceusedisorder
#Recovery
#Wedorecover
#Blackharmreduction
#Mobilehealthreduction
#Mobile health
#Publichealth
#Opioidcrisis
#Overdoseprevention
#Msp
#Minneapolis
#Mpls

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