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MeziTouch Rehab: Addiction Self-Assessment Form

Questionnaire
A. Substance Addictions:
B. Behavioural Addictions:

Disclaimer:

This form is a self-assessment tool designed to assist MeziTouch Rehab in understanding your needs and providing appropriate care.

Completion of this form does not constitute a formal diagnosis. All information provided is strictly confidential and will only be used by qualified professionals involved in your care. If you're in immediate danger or experiencing a crisis, please seek emergency assistance.

By submitting this form, you acknowledge that the information is accurate to the best of your knowledge.