Substance Abuse Risk Assessment
Please note, this assessment should not substitute a medical checkup or consultation with a physician. Only a physician, or other qualified health care provider, can accurately diagnose and treat substance abuse.

In order to process your free assessment, please complete the information below so one of our health care professionals may assist you. Your personal information is confidential and will not be shared or used for any purposes other than this assessment.
Is your life controlled by drugs or alcohol?


Please answer this question.
Do you find it difficult to manage your withdrawal symptoms on your own?


Please answer this question.
Are you ready to take the next step on the road to recovery?


Please answer this question.
Your treatment may be covered under your current health insurance. Do you have Medicaid, Medicare, government or commercial health insurance?


Please answer this question.
First Name:
Last Name:
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