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K. Johns MedicalMedical & Behavioral Health

Screening · About 3 minutes

Substance-use screening

These questions are about health and safety, not judgment. Honest answers help us prescribe and treat safely.

About you

Please give at least a telephone number or an email address so the office can reach you.

Alcohol
How often do you have a drink containing alcohol?*
How many standard drinks do you have on a typical day when you are drinking?*
How often do you have six or more drinks on one occasion?*
Tobacco, cannabis, and other substances
Do you use tobacco or nicotine products, including vaping?*
In the past year, how often have you used cannabis?*
In the past year, have you used a prescription medication in a way other than prescribed?*
In the past year, have you used any other non-prescribed substance?*
Has anyone expressed concern about your substance use, or have you wanted to cut down?*

Your responses are scored automatically when you submit. A score is not a diagnosis and is always reviewed by a clinician.

Submitting sends your answers directly to K. Johns Medical over an encrypted connection and creates a PDF for your clinician. It does not book an appointment and is not monitored in real time. For an urgent concern, call the office. In an emergency, call 911 or call or text 988.

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