Screening Forms - PursueCare

Screening Forms

Please answer the questions below.

  • OPIATE SCREENING

    The Subjective Opiate Withdrawal Scale (SOWS)

    Answer how you feel about each symptom RIGHT NOW.




  • Brief Addiction Monitor

    Instructions: This is a standard set of questions about several areas of your life such as your health, alcohol and drug use, etc. The questions generally ask about the past 30 days. Please consider each question and answer as accurately as possible.




  • ALCOHOL SCREENING

    CAGE Questionnaire




  • Self-Administered Short Michigan Alcoholism Screening Test (SMAST)




  • GENERAL DRUG SCREENING

    DAST 10
    These Questions Refer to the Past 12 months




  • CAGE-AID Questionnaire




  • Skinner Trauma History
    Since your 18th birthday, have you:




    • Date Format: MM slash DD slash YYYY