Breakthrough Call Questionnaire

Please complete the application at least two full days before our call.

Thanks for connecting to schedule a Breakthrough Call! You have reached a crucial milestone in your quest to take control of your drinking. I often say the hardest part of the journey lies in acknowledging your need to make control the goal, and that reaching out for help is one of the biggest steps in achieving that.

Below I have listed a few questions that will aid us in getting to know one another on our upcoming call. The goal of that call is for me to get to get a sense of where you’ve been, where you are, and where you want to be. It’s also for you to get to know me. Understanding these things will be key to us determining our fit and deciding our course of action moving forward.

Please answer the following questions as honestly and accurately as possible and add any additional info you wish.