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GETWELE RECOVERY & WELLNESS CENTER
Assessment/Evaluation
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GETWELE COMMUNITY ADDICTION ASSESSMENT BATTERY (GCAAB)
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1. Member ID:
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Your answer
2. Date:
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MM
/
DD
/
YYYY
3. Age:
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Your answer
4. Last Name:
*
Your answer
5. First Name:
*
Your answer
6. Address:
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7. City:
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8. State:
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9. D.O.B:
*
Your answer
10. Sex:
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11. Marital Status:
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Your answer
12. Referral source:
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Your answer
13. Reason for referral:
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