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Substance Group Supplemental Intake Checklist

Document Name
Participant Initials
Staff Initials
Substance Group Consents
ASAM Paper Criteria
PHQ-9
GAD-7
Columbia Suicide Severity Rating Scale
SAFERR Screening Instrument
Addictions Recovery Plan
BPSA
Treatment Plan

By signing below, I acknowledge that I have received and reviewed the above documents.


Clear Signature
Clear Signature
Clear Signature
Client Signature
Client Signature
Staff Signature