Assessment Form for Gambling

Help us to know more and understand your specific needs as well as your personal, medical and addiction history. Assessments can be done through phone but we encourage you to fill out our Online Personalized Client Assessment Form.

Personal Information

Pre-Assessment for Gambling

The primary language used at the center is English. Do you have a problem with understanding, reading or writing the English language?(Required)
Do you feel it necessary to preform a clinical therapeutic intervention? If so would you provide us explicit permission to do so? *
Select the programs you are interested in:(Required)