Personal History Explain to the best of your ability what brought you to treatment. When was the most recent time you used? Please list your drugs of choice. Please separate using a comma, each drug and how long you have used it. * Please list in order the treatment centers you have attended and approximate dates. * Have you ever been clean and sober, if so how long? * Have you ever been clean and sober, if so how long? Do you fail to fulfill responsibilities at work, school, or home? * Yes No Do you use in situations, which are dangerous to your life? Yes No Please check Yes or No to the behavioral problems that apply. * Yes No Did you lose your job due to usage? * Yes No Frequent Arguments/Argrumentative * Yes No Separation/Divorce due to use * Yes No Life has become unmanageable. * Yes No CPS or legal problems * Yes No Criminal Problems * Yes No |Welcome| |Our Mission| |Our Services| |The TC| |For Women| |Children Services| |Exec. Director| |Health Center| |Job Training| |Outpatients| |FAQ| |Admissions| |Adm. Personal History| |Adm/Med/history| |Adm./Psycho/History| |Directions| |Odyssey Links| |Contact Us| |About| Hosted by AbleTeam.com