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Confidential Online Treatment Assessment

 
     
 

Once a full assessment is taken, client needs are assessed and a treatment plan is drawn together where length, type and intensity of treatment are determined with a team of professionals.

 

When assesing whether or not someone has a drug or alcohol problem treatment professionals are best to help to determine to what degree or if at all a person has a drug or alcohol dependence that deserves professional treatment. It is important that a full assement be taken by a trained and qualified couselor. While most people have a very firm belief in what deems use, misuse and abuse, the lines are very clear and are best determined when a full client history can be taken. The sociological background, psychological makeup, educational and work history, family and marriage difficulties and medical issues all have to be taken into account and weighed carefully against specific criteria that determine the prevalance of a chemical dependency problem.

In many cases where all of these factors and histories can be documented and reviewed by a counselor, the need for screening inventories does not weigh as heavily, but in the short term can give the professional a good idea of whether a chemical dependency issue is at heart of the clients' problems.

To receive an online consultation from one of our admissions personnel, please fill out the form below and please be sure to include your first name an email address and / or phone number so that we may contact you to schedule a more complete consultation appointment. This service is a free of charge and requires no commitment from you or your family.


Note: any and all information submitted is completely confidential and protected by 42CFR under the Federal Guidelines of Client Confidentiality.

Contact Information

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First Name:

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Last Name:

 
E-mail Address:

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Phone Number:

 
Alternate Phone:

 
State:

 
You are contacting Support Systems Homes for:   Self
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Drug and Alcohol History

 

What Is The Primary Drug of Abuse?

   
 
Method of Intake?

 
What Is The Secondary Drug of Abuse?

 
 
Method of Intake?

 
At What Age Did The User First Take Drugs?

 
How Old Is The User Now?

 
At What Age Did The User's Life Begin To Be Unmanageable?

 
Presently What Are The Resulting Problems of The User's Addiction?  
What Is The Family's Attitude Toward The User's Addiction?  
Does The User Admit To Having A Problem?

  yes  no 
Does the user want help?

    yes  no
     

Treatment History

 

How Many Times Has This User Been In Treatment for Their Addiction?

 
How Many of These Involved The 12-Step (AA/NA Model) Approach To Recovery?

 
Was There Any Success With Any Of These Treatment Episodes, and if so, what was the length of sobriety achieved?

 
     

Medical History

 

Does The User Have Any Known Medical Conditions?

 
If So, Please List The Condition(s) And Any Necessary Details:

 
Has This Person Ever Been Diagnosed With Any Psychiatric Disorders?

 
If so, is He / She Currently On Medication for A Psychiatric Disorder?

 
If So, Please Specify Medications Taken:

 
Does The User Have Medical Insurance?

 
If so, who is the Insurance Carrier?
 
     

Additional Info

Does The User Have Legal Issues?

 
If So, Please Describe

 
Please Provide Us With Any Other Information and Any Questions You May Have In The Area Below  
     
     

 



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