Name: Executive Treatment Solutions
Address: 468 N Camden Dr, Beverly Hills, California, 90210
Telephone: (310) 872-1858
Price range: $
Rating: 5

Executive Treatment Solutions Intake Form

Please complete the form below after confirming that the client or their family is interested in treatment options.

Defendant full Name

Defendant D.O.B

City/County of Arrest

Case Details (Booking #, Jail, Charges, etc.):

Submitter's Full Name

Submitter's Phone Number

Relationship to Defendant:

Defendant currently in custody?

Has an attorney been retained?

Type of Information

Best Time to Call You Back

Name of Agent Submitting