Free Drug Assessment

Free Drug Assessment and Treatment Form:

This online service is provided free of charge as a public benefit service and all information received from clients is confidential. Response time is usually 48 hours or less, and is in the form of a confidential e-mail. In some instances phone contact may be appropriate and necessary to better assess the situation, or in the case of an emergency where the call was requested by the individual. In the event of a phone call the counselor will only identify themselves to the contact person listed below, and will advise all others that this a personal call and will not disclose who we are or why we are calling.

For faster assistance please call us now. We are here to take your call 24 hours a day, 7 days a week. 


In assessing the problem and deciding on treatment options, several factors that are typically used in assessing an individual’s level of addiction. These factors include:
Prior alcohol and drug use history;
Family history and Ethnic/Cultural background;
Social history;
Legal history;
Educational history;
Occupational history;
Medical history;
Psychological and behavioral problems.
Below you will find questions pertaining to these areas, it is important that you answer them as accurately as possible. This information is requested, however it is not required for a referral:

Please fill-out the form below so we can assess and refer your information to the treatment center which best suits your needs. Code 42 of Federal Regulations forbids parishioners to disclose the identities of persons inquiring about drug rehab services – even if they are never admitted to the facility.

For immediate assistance call 1-866-391-6530

hotline for drug addiction

Contact Information:
A). General Contact Information:
B). Substance Abuse History:
C.)Family History
D). Social History
E.) Legal History:
F). Educational History:
G). Occupational History
H). Medical History:
I). Psychological and Behavioral History:

christian drug and alcohol treatment
Service Type
Free Online Drug Assessment
Provider Name
Christian Drug Rehabilitation
Online free assessment for drug addiction
Fill out this free online drug assessment form and one of our counselors will contact you within 36-48 hours. for immediate assistance call us at 1-866-391-6530.