This addiction screening & assessment form is designed for early intake and screening in counseling, treatment, and behavioral health settings. It gives providers a consistent way to collect essential background details, including contact information, preferred follow-up method, the primary substance of concern, and any other substances used regularly.
The question flow also supports a more informed initial review by covering how long substance use has been happening, how often it occurs, and whether the person has struggled to cut down. Questions about tolerance and withdrawal help surface warning signs that may affect urgency, level of care, and the next step in the assessment process.
Because the form is already organized around common screening needs, it can reduce back-and-forth before an intake call or appointment. Teams can customize it for their population, treatment setting, or clinical workflow while keeping the screening experience clear, direct, and easier for respondents to complete.
