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SUBSTANCE ABUSE QUESTIONNAIRE NAME: DATE: Please carefully read through the list below of different types of drugs/chemicals. Please put an X by any of the substances that you have used, even if only

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5. - Start filling out the form one section at a time, following the provided instructions and guidelines.
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9. - Review the entire form again to ensure there are no errors or omissions.
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11. - Make a copy of the filled-out form for your records before submitting it.
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