Online Assessment Form
Fill out and submit the Addiction Assessment form at the right, and
call 1.800.468.6933 to speak
with an admissions counselor.

Addiction Series
Cocaine
Methamphetamine
Ecstasy
Heroin
Marijuana
Alcohol

Narconon Links
Stop Addiction
Narconon Center
Narconon International

Narconon Arrowhead Drug Rehabilitation and Education Center

1-800-468-6933

Contact Information:

Last Name:

First Name:

M.I.

Address:

City:

State:

Zip Code:

School Name:

Phone:

E-mail:

Grade Levels:

# of Students:

Prevention History:

Has your school ever had a drug prevention program? yes no

If so, what kind of program ?

Was it a fee-for-service or a free-of-charge program ? fee-for-service free-of-charge

What effect did this program have ?

Were you satisfied with the outcome of the program? yes no

Does your school have any alcohol/drug-related problems that you are aware of? yes no

If yes, please describe them:

Other Information:

Does your school want more presentations about drugs/alcohol ? yes no

Please describe briefly what is going on with yourschool right now.
Also add any other information that we should know (best time to call, etc):

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