Home
Forms Library
Treatment needs questionnaire

Treatment needs questionnaire 2025

treatment needs questionnaire Preview on Page 1

See details

4.9 out of 5

55 votes

The document is Vermont's Treatment Needs Questionnaire, designed to assess patients' suitability for medication-assisted treatment (MAT) for substance use disorders. It includes a series of questions regarding drug use history, medical and psychiatric issues, social support, and stability factors. The questionnaire scores responses to categorize candidates for different levels of treatment, ranging from excellent candidates for office-based treatment to those requiring more intensive care in a structured program.

Here's how it works

01. Edit your treatment needs questionnaire online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out treatment needs questionnaire with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the treatment needs questionnaire in the editor.
Begin by entering the patient’s name and ID at the top of the form, along with the date and staff name/ID for proper identification.
Proceed to ask each question listed in the questionnaire. For each question, circle 'Yes' or 'No' based on the patient's response.
Pay special attention to questions regarding past medication-assisted treatments and any chronic pain issues, as these are crucial for assessing treatment needs.
After completing all questions, calculate the total points based on the responses. This will help determine the appropriate treatment pathway for the patient.

Start using our platform today to easily fill out your treatment needs questionnaire online for free!

See more treatment needs questionnaire versions

We've got more versions of the treatment needs questionnaire form. Select the right treatment needs questionnaire version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2016	4.9 Satisfied (55 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the treatment effectiveness questionnaire?

The TEA asks the patient to express the extent of changes for the better from his/her involvement in the program to the current point (or how things are at baseline, for the first TEA) in four areas: substance use, health, lifestyle, and community.

What is the 10 questionnaire for addiction?

The DAST-10, or Drug Abuse Screening Test, contains 10 yes or no questions relevant to how often you use the drug, how the use of the drug affects your well-being and relationships with others and any physical or psychological symptoms you experience as a result of using the drug.

What is the treatment entry questionnaire?

Treatment Entry Questionnaire: 9-item (TEQ-9). The TEQ-9 is a measure of extrinsic motivation for SUD treatment (Urbanoski and Wild, 2012). The scale consists of one four-item, one three-item, and one two-item subscale which measure identified regulation, introjected regulation, and external regulation, respectively.

What is a treatment needs assessment?

A treatment needs assessment (TNA) is the first step in determining if someone needs further help with their addiction, substance use disorder and/or other mental health issues. TNAs typically take one to two hours.