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(406) 453-5080

Home
About Us
- Our Team
- Testimonials
- Tour
- FAQ
Treatment Programs
Resources
Admissions
Contact Us

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Alcohol Misuse Survey

Welcome To Your Alcohol Misuse Survey.

Please Choose the Answer That Best Describes You.

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How often do you have a drink containing alcohol?*

Never

Monthly or less

2-4 times a month

2-3 times a week

4 or more times a week

How many standard drinks containing alcohol do you have on a typical day when you are drinking?*

1-2

3-4

5-6

7-9

10+

How often do you have six or more drinks on one occasion?*

Never

Monthly or less

Two to four times a month

Two to three times a week

Four or more times a week

How often during the last year have you found that you were not able to stop drinking once you had started?*

Never

Monthly or less

Two to four times a month

Two to three times a week

Four or more times a week

How often during the last year have you failed to do what was normally expected from you because of drinking?*

Never

Monthly or less

Two to four times a month

Two to three times a week

Four or more times a week

How often during the last year have you had a feeling of guilt or remorse after drinking?*

Never

Monthly or less

Two to four times a month

Two to three times a week

Four or more times a week

How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?*

Never

Monthly or less

Two to four times a month

Two to three times a week

Four or more times a week

How often during the last year have you been unable to remember what happened the night before because you had been drinking?*

Never

Monthly or less

Two to four times a month

Two to three times a week

Four or more times a week

Have you or someone else been injured as a result of your drinking?*

No

Yes, But not in the last year

Yes, During the last year

Has a relative or friend, or a doctor or other health worker been concerned about your drinking or suggested you cut down?*

No

Yes, But not in the last year

Yes, During the last year

First Name*

Last Name*

Email*

Phone*

To Help Us Reduce Spam Please Answer The Following Question: What Animal Is Featured In Our Logo?*

All fields marked with an asterisk * are required

All fields marked with an asterisk * are required

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Struggling with Addiction?

We've Been There, We Can Help.

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However, currently we cannot accept Medicaid or Medicare as a form of payment. Financing options are available.

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Great Falls, MT 59401

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Contact Us Today

Alcohol Misuse Survey

Welcome To Your Alcohol Misuse Survey.

Contact Us

Struggling with Addiction?

﻿We've Been There, We Can Help.

WE ARE IN-NETWORK WITH INSURERS AND ACCEPT PRIVATE PAY

We've Been There, We Can Help.