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Assessment Survey

An intervention is an involved, multi-step process. This self-assessment test will be submitted to our intervention specialists. Please answer the questions carefully and as completely as possible.

We respect your privacy. Your information will be kept strictly confidential.

Personal Information










Demographic Information



Assessment Questions
 
Yes No
Are you aware of an addiction problem?
Have you accepted the fact there is an addiction problem?
Can you identify addiction related problems?
Are you open to addiction treatment?
Are you in need of constant motivation?
Are you committed to getting help?
Are your expectations for recovery realistic?
Are there any signs of psychological problems?
Is there support from loved ones to get help?
Are you taking any medication?
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