Assesment | ESR

Eastern Shoshone Recovery Program

Dedicated to the Wellness of the Eastern Shoshone People

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Basic Assessment for Mental Health

and Addictions

Name

Email

Check, if when you drink you drink more then 4 drinks a day?

Check, if you have thoughts of hurting yourself.

Check, if you illegally use perscription Opiods or Heroin.

Have you been charged with a drug or alcohol related crime?

Are you seeking help because of a court order?

Are you currently Using Illegal Drugs or Alcohol?

Are you clean and sober today?

Are you Sick and Tired of being Sick and Tired?