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Screening Forms

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Alcohol Use Disorders Identification Test AUDIT & AUDIT-C

Alcohol Use Disorders Identification Test (AUDIT) questionaire is a simple method of screening for excessive drinking and alcohol use disorders. The AUDIT is a 10-item screening screening tool developed by the World Health Organization (WHO) to assess alcohol consumption, drinking behaviors, and alcohol-related problems. The AUDIT-C is a modified version of the AUDIT; it has a 3-item alcohol screen that can help identify persons who are hazardous drinkers or have active alcohol use disorders (including alcohol abuse or dependence.)  

  • Alcohol Use Disorders Identification Test AUDIT  [PDF]
  • The AUDIT Alcohol Consumption Questions AUDIT-C [PDF]

Drug Abuse Screening Test DAST-10

The questions included in the DAST-10 concern information about possible involvement with drugs not including alcoholic beverages during the past 12 months.

Drug Abuse Screening Test DAST-10 [PDF]

Patient Health Quesitonnaire PHQ & PHQ-9

The PHQ is a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression. The PHQ-9 is a shortened version of the PHQ.

  • Patient Health Questionnaire PHQ-9 [PDF]
  • Patient Health Questionnaire PHQ [PDF]

Annual Questionnaire

The annual questionaire combines screening questions from multiple evidence-based screening tools into one tool for providers to use prior to administering the lengthier screening tools.

Annual Questionnaire [PDF]

ASSIST Screening Tool

Alcohol, Smoking and Substance Involvement Screening Test is used to detect and manage substance use and related problems in primary and general medical care settings.

ASSIST Screening Tool [PDF]