Your documents

Start any form on its own, or tick several to complete them together as one packet.

New client intake packet

Registration, consent, billing, authorization and privacy notice.

Evaluation questionnaires

DAST, MAST and BAM in one sitting.

Client Registration & Consent

Start here if this is your first visit.

Client Information

Your contact details, emergency contact, household and reason for your visit.

~6 min

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Consent for Counseling

What counseling includes, confidentiality and its limits, and your consent to services.

~5 min Signature

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Fees & Billing Policy

Service fees, payment terms, insurance details and assignment of benefits.

~4 min Signature

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Authorization to Disclose PHI

Your permission to share specific information with DISA and your company officials.

~5 min Signature

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Notice of Privacy Practices

How your medical information may be used and disclosed, and your rights. Read-only.

~4 min

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Assessments

Short questionnaires about substance use and wellbeing.

Drug Screening (DAST)

Questions about recreational drug use in the past year.

~4 min

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Alcohol Questionnaire (MAST)

25 yes-or-no questions about your drinking habits.

~6 min

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Brief Addiction Monitor (BAM)

17 questions about your health, substance use and recovery over the past 30 days.

~7 min

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Reinstatement & Attendance

Return-to-work agreement and meeting log.

DISA Reinstatement Agreement

The DISA Contractor Consortium return-to-work agreement, completed on the original form.

~3 min Signature

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AA Attendance Log

Record your 12-step meetings. Leader's initials stay blank for the leader to add in person.

~5 min Signature

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