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Cocaine Treatment
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Methamphetamine
Co-Dependency
Family Guide
Family AddictionTherapy
Rehab TreatmentFor Young People
ConcurrentDisorders (DualDiagnosis)
Anxiety Treatment
Depression
Personality Disorder
Program
Hope Workbooks
Online Help
Combined OnlineCourse
Mindfulness
MindfulnessProgram
What isMindfulnessCoaching?
Mindfulness-BasedCognitive Therapy
Therapy
CognitiveBehaviouralTherapy
Group Therapy
Counselling
Trauma Therapy
Massage Therapy
Relapse Prevention
Relapse Triggers
Recovery Coaching
Aftercare
Fitness
Cycling & Swimming
Team Sports
Thai Boxing
Yoga, Thai Chi & Pilates
Gallery
Cost
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About
Testimonials
Media
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Join the Team
Internships
Rooms
Food
We Treat
Detox
Alcohol Addiction
Drug Types
Addiction Treatment
Cannabis Treatment
Cocaine Treatment
Heroin Treatment
MedicationAddictionTreatment
Methamphetamine
Co-Dependency
Family Guide
Family AddictionTherapy
Rehab TreatmentFor Young People
ConcurrentDisorders (DualDiagnosis)
Anxiety Treatment
Depression
Personality Disorder
Program
Hope Workbooks
Online Help
Combined OnlineCourse
Mindfulness
MindfulnessProgram
What isMindfulnessCoaching?
Mindfulness-BasedCognitive Therapy
Therapy
CognitiveBehaviouralTherapy
Group Therapy
Counselling
Trauma Therapy
Massage Therapy
Relapse Prevention
Relapse Triggers
Recovery Coaching
Aftercare
Fitness
Cycling & Swimming
Team Sports
Thai Boxing
Yoga, Thai Chi & Pilates
Gallery
Cost
Menu
Home
Location
BLOG
About
Testimonials
Media
FAQ
Team
Join the Team
Internships
Rooms
Food
We Treat
Detox
Alcohol Addiction
Drug Types
Addiction Treatment
Cannabis Treatment
Cocaine Treatment
Heroin Treatment
MedicationAddictionTreatment
Methamphetamine
Co-Dependency
Family Guide
Family AddictionTherapy
Rehab TreatmentFor Young People
ConcurrentDisorders (DualDiagnosis)
Anxiety Treatment
Depression
Personality Disorder
Program
Hope Workbooks
Online Help
Combined OnlineCourse
Mindfulness
MindfulnessProgram
What isMindfulnessCoaching?
Mindfulness-BasedCognitive Therapy
Therapy
CognitiveBehaviouralTherapy
Group Therapy
Counselling
Trauma Therapy
Massage Therapy
Relapse Prevention
Relapse Triggers
Recovery Coaching
Aftercare
Fitness
Cycling & Swimming
Team Sports
Thai Boxing
Yoga, Thai Chi & Pilates
Gallery
Cost
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Online assessment
Online assessment
In the following self-assessment, please answer the questions honestly either yes or no:
Drug of choice? (please select, required)
Not applicable
Alcohol
Benzodiazepine
Cannabis
Cocaine
Heroin
Methadone
Subutex
Amphetamines
Ice/Crystal Meth
Prescription Medication
Is your using or drinking increasing in amount?
Yes
No
Have you felt decrease in effect?
Yes
No
Have you ever felt any withdrawal symptoms or shakes?
Yes
No
Ever taken in larger amounts and for longer periods than intended?
Yes
No
Any repeated unsuccessful attempt to quit?
Yes
No
In the past have you been in trouble at school, work or with the law as a result of drinking or drug use?
Yes
No
In the past year has your drug use or drinking caused problems at home with your family, children, parents or spouse?
Yes
No
Use continues despite knowledge of adverse consequences or against professional advice?
Yes
No
When drinking with other people, do you try to have a few extra drinks when others won’t know about it?
Yes
No
Do you use or drink alone?
Yes
No
Do you sometimes feel a little guilty about your drinking or using?
Yes
No
Has a family member or close friend express concern or complained about your using/drinking?
Yes
No
Have you been having more memory “blackouts” recently?
Yes
No
Do you usually have a reason for the occasions when you use/drink heavily?
Yes
No
When you’re sober, do you sometimes regret things you did or said while using/drinking?
Yes
No
Have you sometimes failed to keep promises you made to yourself about controlling or cutting down?
Yes
No
Do you try to avoid family or close friends while you are using/drinking?
Yes
No
Have you ever gone to anyone for help?
Yes
No
Have you experienced any seizures?
Yes
No
Detox required?
Yes
No
Your details:
Your Name (required)
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Your Age (required)
Your Nationality (required)
Your Email (required)
Your Telephone Number (required)
Medical issues?
Personal issues?
Health issues?
Mental health diagnosis?
History of suicide?
Are you on any prescription medication?
Any other information?
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