CRAFFT Form (Select Appropriate Clinic)

For which clinic is this form?
Enter a confirmation email address.

During the PAST 12 MONTHS, on how many days did you:

Please answer the following also.

4. Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs?
5. Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
6. Do you ever use alcohol or drugs while you are by yourself, or ALONE?
7. Do you ever FORGET things you did while using alcohol or drugs?
8. Do your FAMILY or FRIENDS ever tell you that you should cut down on your drinking or drug use?
9. Have you ever gotten into TROUBLE while you were using alcohol or drugs?