Toggle navigation preboarding v1.6 default Caution: JavaScript execution is disabled in your browser or for this website. You may not be able to answer all questions in this survey. Please, verify your browser parameters. Free Counseling With a Licensed Counselor Please answer the following questions to be connected with our licensed therapist for a free counseling session. General I am taking Opiods or Benzos for my pain or anxiety. I need help to taper off slowly I have a surgery coming up. I'm nervous and anxious about my diagnosis and recovery I have cancer. I'm nervous and anxious about my diagnosis and recovery I am feeling anxious and depressed and need help I have chronic or acute pain and I am looking for pain relief I am interested in joining a Support Group offered by Lucid Lane Test Entry (This question is mandatory) By sharing the information below we will be better prepared when we contact you. Name: Phone: Email: Enter year you were born (we cannot accept minors): Select your health insurance: Name of your health insurance company: Which state do you reside in? Are you currently on disability? Next Please confirm you want to clear your response? Exit and clear survey ×