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  • If you feel like you are having an emergency, or if you are in serious withdrawal, please stop and call 911. This process can wait.

  • We developed this online assessment to expedite the process it takes to get you connected to the right kind of care. It is important that you are in a safe and private place while completing this survey. Please continue when you are in a safe and private space.

  • Please use the buttons on the bottom of each section to navigate through the assessment. Avoid using the back buttons in your browser or refreshing the page as your progress could be lost. 

  • You indicated that you might need assistance, have completed an assessment recently or are already enrolled in a treatment program. You may not need to complete this form, please call us at 612-895-1510 or text 612-712-6879 and we will help you with next steps.

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  • GAIN-SS Screener

  • The following questions are about common psychological, behavioral, and personal problems. These problems are considered significant when you have them for two or more weeks, when they keep coming back, when they keep you from meeting your responsibilities, or when they make you feel like you can’t go on. After each of the following questions, please tell us the last time, if ever, you had the problem by answering whether it was in the past month, 2 to 3 months ago, 4 to 12months ago, 1 or more years ago, or never.

  • When was the last time that you had significant problems with...

  • IDScr

  • When was the last time that you did the following things two or more times?

  • EDScr

  • When was the last time that...

  • SDScr

  • When was the last time that you...

  • CVScr

  • Dimension 4: Readiness for change

  • It is important to recognize signs of overdose. Here are some likely signs that someone is overdosing:

    Face is extremely pale and/or feels clammy to the touch, body goes limp, fingernails or lips have a purple or blue color, they start vomiting or making gurgling noises, they cannot be awakened or are unable to speak, breathing or heartbeat slows or stops.

  • Dimension 1: Intoxication/withdrawal start

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  • Dimension 1 end

  • wSOWS: We want to know how you are feeling right now. Please indicate how you feel about each of the symptoms listed below.

  • Dimension 5: Substance use risks

  • How many times or for how long have you been to each of the following?

    Please estimate if you are unsure.

  • Dimension 3: Mental Health Start

  • PTSD (PCL-5)

  • Below is a list of problems that people sometimes have in response to a very stressful experience. Please read each problem carefully and then let us know how much you have been bothered by that problem in the past month.

  • GAD-7

  • Over the last two weeks, how often have you been bothered by the following problems?

  • PHQ-9

  • Over the last two weeks, how often have you been bothered by any of the following problems?

  • MDQ

  • Has there ever been a period of time when you were not your usual self and...

  • ARS V.1.1

  • Please answer the questions below, rating yourself on each of the criteria shown using the scale on the right side of the page. As you answer each question, check the box that best describes how you have felt and conducted yourself over the past 6 months.

  • SCOFF

  • Y-BOCS

  • The following questions are about compulsions. Compulsions are repetitive behaviors or mental acts that you have a strong urge to repeat that are aimed at reducing your anxiety or preventing some dreaded event.

  • ZAN-BPD

  • Mental Health Cont.

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  • Biomedical

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  • Dimension 4 - Readiness for change

  • On a scale from 0-10, how much support do you need in the following areas? 0 being no support at all and 10 being a significant amount of support in this area.

  • Dimension 6 - Recovery Environment

  • Dimension 4 - Readiness for change

  • Our main goal is to help you find treatment and resources that would be most helpful to your recovery. Please rate the following options on a scale of 0 (not helpful at all) to 10 (extremely helpful).

  • You made it! Great work. Hit "Submit" and we will contact you to set up an appointment with a counselor.

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