Online Assessment

CONFIDENTIAL DRUG/ALCOHOL ASSESSMENT

If you or someone you know is Addicted to Drugs or Alcohol, we are here to help.

For immediate assistance you can call 1300 88 7676 or complete the online assessment form below and one of our Intake Counsellors will contact you shortly.

If you have security concerns:

Unless required by law, the information you provide here will not be disclosed to any other agency and will be treated with the utmost confidentiality and privacy. However, if you are concerned about filling out the online assessment below, please contact us and we will arrange a phone consultation.

 

First
Last

Drug History

Please indicate which Drug(s) are involved in the problem:

Treatment History

Medical History

Legal History

Other Information

Answer the following math question

 

 

 

 

Call 1300 88 76 76
1300 88 76 76 fbq('track', 'Lead');
Contact Us
close slider
  • This field is for validation purposes and should be left unchanged.