CWCS Salisbury Screening Form
Welcome to CWCS! This form is a quick way for us to get to know you and understand what kind of support you may need. Your answers are confidential and used to help us connect you with the right services. Please answer as honestly as you can, and if you’re unsure about a question, just let us know—we’re here to help. Having this information helps us understand what kind of support you qualify for.

(All responses are confidential and used only for your care planning.)
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DEMOGRAPHICS
This will be where you enter your personal information, so that we can determine if you are eligible for CWCS services.
Meeting Date *
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Clients Name *
Date of Birth *
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Do you have a Phone? *
If not that is okay, your peer can work with you to hopefully help you purchase one.
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