Get Substance Abuse Questionnaire

Filling out the Substance Abuse Questionnaire online is an important step in providing necessary information regarding substance use. This guide will help you navigate the form, ensuring that you complete each section accurately and confidently.

Follow the steps to complete the Substance Abuse Questionnaire effectively.

1. Click the ‘Get Form’ button to access the questionnaire and open it in your online editor.
2. Begin by entering your personal information, including your name, sex, height, weight, date of birth, and whether you are a smoker.
3. Indicate your desired coverage amount and plan, choosing appropriate options based on your preferences.
4. Respond to whether you currently use alcoholic beverages. If yes, provide details such as frequency of use, type of beverages, and amount consumed.
5. Answer if you have ever consumed more alcohol than you do now. If yes, explain when and describe your previous drinking habits.
6. Indicate whether you have used any illegal or controlled substances. If yes, list the drugs, amount, frequency of use, and duration.
7. State if you have faced any personal or employment problems due to alcohol or drug use and provide explanations as necessary.
8. Answer if you have been charged with DUI or related traffic violations involving substance use, including an explanation if applicable.
9. Indicate if you have ever consulted a physician or received treatment for substance use issues, providing details if necessary.
10. Respond if you have participated in self-help groups and include information about your attendance frequency.
11. Provide your most recent blood pressure and cholesterol readings, along with any diabetes diagnosis and related medication information.
12. Complete the broker's information section, including name, address, phone, fax, and email.
13. Once the questionnaire is complete, save your changes. You may also download, print, or share the form according to your needs.

Complete your Substance Abuse Questionnaire online today for a smoother processing experience.