AC-OK Adult

This questionnaire is designed to screen for some of the most common mental health, trauma related, and substance abuse problems that people seeking counseling may experience. We are required by the State of Maine to use this screening tool. However, you may skip any question that you do not want to answer. Your answers will remain confidential. They are not shared with the State, your insurance company, or anyone other than your therapist without your permission.

This screening is not intended to diagnose any disorder. It is only designed to give your therapist some begining information to help them focus on the most important areas during your upcoming sessions. Your therapist will follow-up with you during your first session regarding any of the "yes" answers you provide, and you will have the opportunity to go into more detail during your first appointment.

Some of these questions may be difficult to answer. If you feel that you are in a crisis, you do not have to wait until your appointment to get help! You may call 1-888-568-1112 for Crisis Response Services 24-hours a day, 365 days a year.
    This is a required question
    This is a required question