Pre-assessment – The Peniel Place

Pre-Assesment

Embark on Your Journey to Healing

Welcome to The Peniel Place's Conversational Pre-Assessment. Begin your transformative path to recovery by answering a few simple questions. Your well-being matters, and we're here to guide you every step of the way...

Let's Create Your Account

Hi, nice to meet you. What's your name?

What's your email address?

Enter Desired Password

Let's start your consultation

Over the next 5 minutes, we'll ask you some questions...

at the end, our team of experts will provide you with recommendations based on your individual circumstances.

and don't worry, all your information will be kept confidential and not shared with any third parties. If you want to go back at any point to amend your answers, please click on 'Previous' in the bottom left hand corner.

Who are you seeking help for?

How old are you (is she/he)?

Male or Female?

Male

Female

What Country/state/Province do you (does he/she) live in?

Based on your results we may want to look at the next steps with you, is that okay?

So, let's look at how you/she/he/ are feeling

Do you (does he/she) often feel tired?

All the time

Sometimes

Energy levels are good

Do you (does he/she/) ever feel anxious, depressed, overwhelmed or stressed?

Pretty much all the time

Sometimes

Never

Tell us why you/he/she are doing this consultation?

My/his/her/ relationships, work and finances are being affected

I'm/he's/she's/ sick and tired of feeling sick and tired

My/his/her life is falling apart

I'm/he's/she's at the end of the line and can't go on anymore

Other

Ready to get help?

Yes

Let's find out what the habit is...

What type of disorder are You (is he/she) currently dealing with?

What substances do You (does he/she) use?

How often do You (does he/she) gamble?

How often do You (does he/she) take these substances?

How often do You (does he/she) drinks?

Roughly how much do You (does he/she) spend a day on these?

What happens when You're /he's/she's not drinking/ gambling/ taking a substance ?

Are any of the following a problem for you/him/her/?

Any history of seizures?

Yes

Not Sure

Do You (does he/she) use any illegal substance?

Yes

Not Sure

What about any prescription meds?

Yes

Not Sure

How long has this been going on for?

Last few months

The last year

Few years

Feels like forever

Have You (he/she) ever had any help trying to stop?

Yes

Not Sure

Any diagnosed mental health conditions?

Yes

Not Sure

Any history of self harm/ suicide attempt?

Yes

Not Sure

Best way to contact you

Our Consultants will get in touch with you regarding your enrollment in the mean time we are taking you to our treatment breakdown, if you have questions regarding the enrollment pricing and payment feel free to reach out to us through out contact page...