Client Questionnaire
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First, are you 21 or over (we can only treat clients 21 and over)? *
Is your preference to stop drinking completely or to continue but just cut back? *
Do you feel drinking is causing weight gain and you would like to lose some weight? *
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, and you would like to eliminate these restrictions? *
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. *
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This form was created inside of Report Abuse