Alcohol and Drug - DUI Evaluation

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If you need to complete a DUI evaluation, please complete the following forms:

Please click the icon to the left to fill out the the DUI evaluation - 

Or you can copy and paste this link into your browser to access the Alcohol and Drug Evaluation for DUI's:
https://form.jotform.com/81564354666162

You will also need to complete the following forms:

Clinical Evaluation Contract

All First DUI Offender Clients

All Multiple DUI Offender Clients (Only complete this if you have more than one DUI in your life)

Consent for the Release of Information (gives us permission to send your evaluation to your referral source)

Alcohol and Drug - Non-DUI Evaluation

If you need to complete an alcohol and drug evaluation that does not involve a DUI, please complete the following forms:

Please click the icon to the left to fill out the the DUI evaluation - 

Or you can copy and paste this link into your browser to access the Alcohol and Drug Evaluation for DUI's:
https://form.jotform.com/81564354666162

You will also need to complete the following forms:

HIPPA Notice of Privacy Practices

Consent for the Release of Information (gives us permission to send your evaluation to your referral source)