Pre-Assessment Form 2026

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The document is a Pre-Assessment Form designed for clients at ASAC, collecting personal information such as name, date of birth, gender identity, ethnicity, race, and health details. It includes sections on gambling behavior, mental health concerns, legal history, and current living situations. The form aims to gather comprehensive data to assess the client's needs for treatment and support services.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your name and date at the top of the form. This personal information is essential for identification purposes.
Proceed to fill in your date of birth and gender identity. If you have gone by any other names, please include that information as well.
Next, check the appropriate boxes under ethnicity and race. You can select multiple options if applicable.
Continue through the sections regarding health information, communication preferences, and any concerns related to gambling or substance use. Be honest in your responses for accurate assessment.
Complete the sections on education, finances, and living situation. Provide details about your current healthcare providers if relevant.
Finally, review all entries for accuracy before submitting the form. Ensure that all required fields are filled out completely.

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