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(406) 453-5080

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

Drug Abuse Survey

Reach Out Now

Welcome To Your Drug Abuse Screening Test

Please Choose the Answer That Best Describes You.

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Have you ever been arrested for driving under the influence of drugs?*

Yes

No

Have you ever been in a hospital for medical problems related to your drug use?*

Yes

No

Have you ever gone to anyone for help for a drug problem?*

Yes

No

Can you get through the week without using drugs (other than those required for medical reasons)?*

Yes

No

Has any family member ever sought help for problems related to your drug use?*

Yes

No

Do you try to limit your drug use to certain situations?*

Yes

No

Have you ever lost friends because of your use of drugs?*

Yes

No

Have you gotten into fights when under the influence of drugs?*

Yes

No

Do you abuse more than one drug at a time?*

Yes

No

Have you ever been arrested because of unusual behavior while under the influence of drugs?*

Yes

No

Have you ever been in trouble at work because of your use of drugs?*

Yes

No

Does your spouse (or parents) ever complain about your involvement with drugs?*

Yes

No

Have you abused prescription drugs?*

Yes

No

Have you had "blackouts" or "flashbacks" as a result of drug abuse?*

Yes

No

Have you ever experienced withdrawal symptoms as a result of heavy drug intake?**

Yes

No

Have you ever lost a job because of drug abuse?*

Yes

No

Has drug abuse ever created problems between you and your spouse?*

Yes

No

Have you used drugs other than those required for medical reasons?*

Yes

No

Have you ever neglected your family or missed work because of your use of drugs?*

Yes

No

Have you engaged in illegal activities in order to obtain drugs?*

Yes

No

Have you ever been arrested for possession of illegal drugs?*

Yes

No

Do you ever feel bad about your drug abuse?*

Yes

No

Do your friends or relatives know or suspect you abuse drugs?*

Yes

No

Do you abuse drugs on a continuous basis?*

Yes

No

Are you always able to stop using drugs when you want to?*

Yes

No

Have you had medical problems as a result of your drug use (e.g. memory loss, hepatitis, convulsions, bleeding, etc.)?*

Yes

No

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.

WE ARE IN-NETWORK WITH INSURERS AND ACCEPT PRIVATE PAY

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

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(406) 453-5080

920 4th Ave N

Great Falls, MT 59401

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