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Pre- Assessment/addiction Questionaire

Freedom Medical Pre- Assessment 

1. Do you acknowledge that you have a problem with opioid or alcohol abuse and requesting treatment for help?

2. Do you currently have any associated legal/criminal, employer, professional license, or child custody issues?

3. Are you willing to commit and sign a professional health-centered, behavioral modification agreement as derived from your initial evaluation and lab results?

4. Are you willing to submit to further psychiatric evaluation, if the initial assessment indicates its necessary?

5. The assessment process results are based upon medical history, physical findings, and lab results to determine treatment and to facilitate this information with other physicians who are involved with your health care and safety. Are you in agreement this information can be shared?

6. Although conference calls, face time and skype counseling are used in counseling, are you willing to agree to a portion of your counseling to be physical?

7. Are you willing to stay committed to the plan that the medical professional has prescribed?

8. Even though the care plan is designed to help with the withdrawal process and Medicated Assessment Treatment, sobriety can be sustained only with a lifetime commitment and follow up with the initial treating physician on a periodic basis. If cravings occur are you willing to be seen by your treating physician or another addictive physician?

9. Do you understand most professionals will attempt to help you be reimbursed for medical expenses? There is no guarantee and payment in full will always be required before any service is given.

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