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Mental Health Assessment - Addiction

The following screening assessment is a short questionnaire used to help identify possible substance dependence.

Please answer honestly. 

Please note: All fields are required.

Have you ever felt that you ought to cut down on your drinking or drug use?
Have people annoyed you by criticizing your drinking or drug use?
Have you ever felt bad or guilty about your drinking or drug use?
Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover?
Which substance or addiction are you concerned about? Select all that apply. Required
Are you taking his assessment for yourself or someone else?
What is your patient status with DPS?
How did you hear about us?

A member of our team will be in touch.

16287 Willow Creek Road

Lewes, DE 19958

262 Chapman Road, Bellevue Building, Suite 233, Newark, DE 19702

Call Us:

302-703-6332

Fax:

302-827-4856

Email Us:

info@dps-wellness.com

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