Initial AssesmentBy KCB Recovery / November 23, 2020 Back to: KCB Recovery MasterClassPlease complete the form below and click the ‘orange‘ submit button at the end of the form to submit the formPlease enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone Number *Country *State *City *Age *18-24 Years25-34 Years35-44 Years45-54 Years55-64 Years65 Years or olderGender *MaleFemaleHow are you feeling today? *GoodBadNeutralHow bothered are you by your drinking or using? *Extremely botheredVery botheredSomewhat botheredNot really botheredNot botheredHow many drinks do you have per day? *How many times per day do you use?How has drinking/Using impacted your life? *What interest do you have or what activities do you like? And how has your drinking/using impacted them? *Are you struggling with anything else? (eg, anxiety, depression, motivation, etc)What are you looking to achieve? *ModerationAbstinenceDrinking only on specific occationsI don't know yetOtherHow did you first hear about KCB Recovery? *What was that one thing that made you decide to sign up for KCB Recovery? *What are you looking forward to most from this program? *What problems are you most looking forward to solving? *What does success look like to you? *What can we do to make you feel taken care of? *SubmitShare this:Click to share on Facebook (Opens in new window)Click to share on X (Opens in new window)Related