PRE-SCREENING QUESTIONAIRE Providing false information on this assessment may result in your application being denied and your eligibility for admission to our program may be revoked.Full Legal Name(Required)Phone or number to leave a message(Required)Email(Required) Do you currently have a substance use disorder? Yes No Once you have submitted this screening, please allow up to 24 hours for a case manager to get back to you. If you do not have a contact number, please feel free to contact us after the 24 hours. Submitting false information on this assessment could lead to the denial of your application and disqualification from consideration for admission to our program. Is there anything you would like to change. pre-screeningquestionaire08.18.25FINAL
