Addiction Questionnaire/Scorer
Knowledge is power - this form is intended to arm you with more insight about how you tick and what makes you, you! 
  • Your information will not be shared with another entity. 
  • The score presented from this questionnaire is not a medical diagnoses. 
  • Please contact us or call 419.285.6655 for an assessment to obtain an official diagnoses. 
  • Symptom medication is available. 
ADDICTION Scoring to meet DSM-V criteria (not official diagnoses) 
Mild: 2-3/11, Moderate: 4-5/11, Severe: 6+/11
Name *
Phone Number *
We will text you only once - based on your score, we'll provide options to manage your symptoms. 
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