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For Immediate Treatment Help Call 1-800-610-4673

The addiction assessment we use is a biopsychosocial evaluation and assessment. This type of drug and alcohol assessment takes into account information from a person's biology, psychological make-up, and social interactions to assess the severity of an individual's addiction.

Our assessment can be taken for yourself or for someone you know.

Fill Out The Form Below To Receive A Call From One Of Our Qualified Addiction Specialists, Or Call Us At 1-800-610-HOPE (4673) For Help Now!

This online service is provided free of charge, and all information received from clients is completely confidential. Response time is usually 24 hours or less in the form of a confidential e-mail or telephone interview. In most instances a Treatment-Centers.net counselor will attempt phone contact to better assess the situation. In the event of a phone call Treatment-Centers.net will only identify themselves to the contact person listed below, and will advise all others that this is a personal call and will not disclose who we are or why we are calling. Please fill out the assessment form to the best of your ability. All fields are not required, and remember - disclosing personal information is not required for assistance or a treatment referral. Confidentiality is of the utmost importance at Treatment-Centers.net. We're here to help!

Note: any and all information submitted is completely confidential

Assessment Form:

Personal Information

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This information is recommended but not required - all correspondence with Treatment-Centers.net is completely confidential in full recognition and cooperation with Federal HIPPA laws.
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Drug History

What Is/Are The Primary Drugs of Abuse?



















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At What Age Did The User First Take Drugs?
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How Old Is The User Now?
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What Are The Resulting Problems of The User's Addiction?
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What Is The Family's Attitude Toward The User's Addiction?
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Does The User Admit to Having a Problem?
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Does The User Want Help?
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Medical History

Has The User Been Diagnosed With Any Mental Health Problems?
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If Yes, Please List The Conditions And Any Necessary Details
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Does The User Have Medical Insurance?
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If Yes, Please Select The Type of Insurance The User Has
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If Necessary, How Much Out-of-Pocket Money is Available for Private Rehab?
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Please Provide Us With Any Additional Information or Questions You May Have Here:
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About Us

Our addiction treatment specialists are available 24/7. Call: 1-888-995-6394
About Us

Treatment-Centers.net is a public benefit service which provides drug addicts, alcoholics, dual diagnosis sufferers, and individuals suffering from other addictions with the largest publicly rated treatment directory online.

Contact Us

  • Add: 1224 N. Hobart St. 210, Pampa, Texas 79065 USA
  • Tel: 1-888-995-6394
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