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  • MessageOfHope
  • Online Assessment

Message of Hope
Online Assessment

This is a brief screening tool that will provide some insight into your situation. The screening is confidential and produces an email, if requested, that is sent to Message of Hope to begin working on your personal recovery.
We are asking for your name and contact information so that, if requested we can contact you to help in our assessment calculations. You are completing this instrument in a secure setting and your information will not be shared in any form. Please also feel free to use a pseudonym if that is more comfortable for you, or leave the name blank.
Name
Please let us know your name.

Would you like to be contacted?(*)
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Phone Number(*)
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Email Address(*)
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Best time to contact you?(*)
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Have you used alcohol or other drugs to the point of intoxication?(*)
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Has your alcohol or drug use caused you problems with family, friends, work, or the law?(*)
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Have you tried to cut down or quit drinking or using drugs?(*)
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Have you attempted to get help due to your drinking or drug use?(*)
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If you answered yes to any of the questions you may be in need of further assessment. Please submit your form and we will contact you or call us at 856-435-1023.
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