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Questionnaire

This survey is designed to help identify the types of substances and behavioral addictions that may be affecting you. By selecting the options that best describe your experiences, you will provide valuable information that can aid in understanding and addressing these issues. Your responses are confidential and will be used solely for informational purposes. Thank you for your participation!

Check those that apply to you:

Substances
Behavioral
Do you experience any of these symptoms?
Date
Day
Month
Year
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