Concerned Persons' Form
Family and friends are affected by those suffering from chemical dependency. Filling out this questionnaire will give the counselors at Cedars a better understanding of your loved ones, and will help with their treatment program during their stay with us.

To help break through denial and further the patients’ treatment, we would like to use this questionnaire to share with the patients and their peers.

Concerned Persons' Questionnaire ( PDF 128kb - PC users can Right-Click to save to their computer for filling-in at their convenience, after printing. Mac users can Control-Click to activate the contextual menu) or CLICK HERE to open the form in a format suitable for online entry and sending to us directly via e-mail.

You will have the option to keep this information confidential.
Thank you.