All your responses are kept strictly confidential and none of your information is shared or stored anywhere else other than within our HIPAA compliant electronic health record system. Let's get started with an idea of your treatment goals.
First, are you 21 or over (we can only treat clients 21 and over).
And, what state do you reside in?
Is your preference to stop drinking completely or to continue to drink but just cut back?
I would like to stop drinking completely
I would like to continue to be able to drink but just cut back
Do you see yourself as having a challenge in stopping to drink once you start and you want to regain control over being able to stop?
Are you not seeing the results you expected from other treatment methods, such as AA, and are ready for a new and science-based approach with a proven, high success rate?
Yes, everything else I've tried hasn't worked well and I want something that will work
No, I haven't tried any other methods yet
Do you feel drinking is contributing to some weight gain and you would like to lose some weight by cutting back?
Yes, I feel drinking has contributed to weight gain and I'd like to cut back for this reason
No, my weight doesn't seem affected from drinking
Do you see yourself as facing some limitations in your social life because you feel a need to avoid other people who drink alcohol, or avoid places where alcohol is present, such as parties, events, weddings, restaurants, dates, brunches or bars, and you would like to eliminate these restrictions?
Yes, I hesitate to be with certain people or go certain places to avoid alcohol
No, I'm able to be with others who drink and go places where alcohol is served
Do you want to improve one or more relationships by cutting back or stopping drinking? This could be a social relationship or something more formal, such as an employment relationship.
Yes, I'd like to cut back or stop to improve one or more of my relationships with others
No, my relationships are fine and I don't feel they have been affected by drinking
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