It’s important to be aware of how your loved one’s substance use disorder could be affecting you. But it’s not an easy challenge to face. Put aside an hour or more to fill out this form with honest answers. We’ll use this information to ensure we provide the best support for you and your needs. Thank you!

Please be advised that Ashley Addiction Treatment staff are mandated reporters of child abuse and neglect, past or present, and vulnerable adult abuse and neglect.