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Web Site Alcohol Screening - Strong Family Health Center

1203 Oak Street Alturas, CA 96101 Phone: 530 233 4591 Fax: 530 233 3055

Web Site Alcohol Screening

    Your Name (required)

    Your Email (required)

    Substance abuse Screening Tool
    CAGE ASSESSMENT

    C

    Have you ever tried to Cut back on your use?

    YesNo

    A

    Have you ever been Annoyed/Angered when questioned about your use?

    YesNo

    G

    Have you ever felt Guilt about your use?

    YesNo

    E

    Have you ever had an Eye-opener to get started in the morning?

    YesNo