"helping put lives back together again"

Home
Self Assessment Form
  1. Your Name(*)
    Please let us know your name.
  2. Phone(*)
    Please write a subject for your message.
  3. Your Email(*)
    Please let us know your email address.
  4. Can Vitanova leave you a message?
    Invalid Input
  5. How can we help(*)
    Please let us know your message.
  6. Do you ever get drunk or high alone?(*)
    Invalid Input
  7. Has drinking or using drugs stopped being enjoyable?(*)
    Invalid Input
  8. Do you find that your choices of friends are selected based on your alcohol/ drug use? (*)
    Invalid Input
  9. Do you drink or use drugs to cope with your feelings?(*)
    Invalid Input
  10. Is it difficult for you to imagine a life without drinking alcohol or using drugs?(*)
    Invalid Input
  11. Do you plan your life around your use of drugs or alcohol?(*)
    Invalid Input
  12. Do you drink or use drugs to avoid dealing with the problems in your life?(*)
    Invalid Input
  13. Are you ever not completely honest about your use of drugs or alcohol?(*)
    Invalid Input
  14. Have relatives or friends ever complained that your use of drugs or alcohol is damaging your relationship with them?
    Invalid Input
  15. Has your use of drugs or alcohol caused problems with motivation, concentration, memory, and relationships, at work or with your health?(*)
    Invalid Input
  16. Have you failed to keep promises you made about cutting down or controlling your use of drugs?(*)
    Invalid Input
  17. Do you feel anxious or concerned about how to obtain more drugs or alcoholic beverages when your supply is near empty?(*)
    Invalid Input
  18.