PIF Adult 3

Health Information

Rate your health:
Your approximate:
Are your presently taking medications?
Have you ever used illegal or abused prescription drugs?
How often do you consume alchohol?
If the counselor belives that it would be helpful to see your psychiatric and/or medical reports, would you be willing to sign an information release form?
If the counselor belives that it would be helpful to see your psychiatric and/or medical reports, would you be willing to sign an information release form?
How would you rate your overall eating habits?