James Fitzgerald Therapy, PLLC

James Fitzgerald, MS, NCC, AAP, Psychotherapist

Strengthening Your Conscious Self © 2022

Intake & Orientation ~ Screening & Assessment

Readiness to Change Questionnaire

Please do not complete this questionnaire/survey unless your therapist has asked you to. Take your time and answer as honestly as you feel comfortable doing. Your answers are anonymous, private and confidential, the only identifying information transmitted is your user ID, which is also your billing and claims account number. Your provider will review the results with you at your next session.

Introduction

The following questionnaire is designed to identify how you personally feel about your drinking right now. Please read each of the questions below carefully, and then decide whether you agree or disagree with the statement. Please tick the answer of your choice to each question. Your answers are completely private and confidential.
Save and Resume Later