Court Orders Clients
1. Please use the following code to report your use of any of the following substances in the past 12 months:
1 = every day 2 = 5 to 6 days per week3 = 3 to 4 days per week4 = 1 to 2 days per week5 = At least 12 times per year6 = Fewer than 12 times per year7 = Never used
When did you last use any of the following substances? Code use according to the following:
Please use the following code to indicate your use of the following substances in your entire lifetime:
I have completed this questionnaire and I verify that my answers are accurate.