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OFFICE USE ONLY ADMIT/PROGRAM: DISCHARGE: ADMIT/PROGRAM: DISCHARGE: Creative Counseling Services, Inc. SUBSTANCE ABUSE INTAKE FORM Client Information: Last Name: DOB: Sex: First: Social Security:
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How to fill out substance abuse services intake

01
Gather all necessary personal information, including full name, contact details, and date of birth.
02
Provide information about any current or previous substance abuse treatment programs attended.
03
Complete a detailed medical history, including any existing health conditions or medications.
04
Answer questions regarding specific substance use patterns and experiences.
05
Provide information about any legal issues or involvement with the criminal justice system.
06
Include details about any family history of substance abuse or mental health issues.
07
Share information about current living situation, employment, and support networks.
08
Sign necessary consent forms and acknowledge understanding of program policies and guidelines.

Who needs substance abuse services intake?

01
Individuals struggling with substance abuse or addiction may require a substance abuse services intake.
02
Those seeking professional assistance to overcome substance abuse issues will need to go through the intake process.
03
People who have recently completed a substance abuse treatment program and wish to continue receiving support may need to fill out an intake form.
04
Those who are concerned about their substance use behaviors and want to explore treatment options would be suitable for substance abuse services intake.
05
Individuals with a history of substance abuse or those who have experienced negative consequences due to their substance use may benefit from the intake process.
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Substance abuse services intake is the process of evaluating individuals who are seeking treatment for substance abuse and determining the appropriate level of care and services needed.
Individuals seeking substance abuse treatment, as well as healthcare professionals conducting the intake process, are required to file substance abuse services intake forms.
To fill out substance abuse services intake, individuals must provide accurate and detailed information about their substance abuse history, medical background, and treatment goals.
The purpose of substance abuse services intake is to assess the individual's needs, determine the appropriate level of care, and create a personalized treatment plan.
Information such as drug and alcohol use history, medical conditions, mental health issues, treatment preferences, and contact information must be reported on substance abuse services intake forms.
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