This questionnaire is for the purpose of getting to know you better in order to provide the best possible mental health services. Please complete this form as honestly and completely as possible. All information that you provide us will be confidential as required by state and federal law.
If applicable, please complete the following:
If so, please give the persona’s name and relationship to you
Please indicate for each drug listed below
Read each of the events listed below, and check the box next to any even which has occurred in your life in the last two (2) years.There are no right or wrong answers. The aim is to identify which of these events you have experienced lately.