Patient Questionnaire

• Have you ever tried to cut down on your drinking or using?
• Do you get angry when people discuss your drinking or using?
• Do you ever feel guilty about things you have done while drinking or using?
• Do you ever use a drink or drug to relieve a hangover?
• Can you now handle more alcohol or drugs than when you first started drinking or using?
• Have you ever driven a car after drinking or drugging?
• Are you having more financial, work, school or family problems as a result of your drinking or using?
• Do you have relatives who have had a problem with drugs or alcohol?
• Do you drink or drug to relieve symptoms or anxiety, or to escape from worries or troubles?
• Have you ever lied to those close to you about the amount or frequency of your drinking or using?
• Do you drink or use alone?
• Have you ever had a complete loss of memory regarding a drinking or using occasion?

With our detailed and individualized treatment programs, we will help you to achieve all your goals for a clearer and brighter future.