Substance Use Screening Form — shared by the community
Yusuf E. shared this 14-question build with 4 conditional rules already wired up. Test it below, then take a copy.
A ready-to-use healthcare & clinical form for small teams who need a reliable intake process: 14 questions, 2 pages, 4 conditional rules.
- Shared by
- Yusuf E. · Recruitment partner
- Questions
- 14
- Replies
- 25
- Copies taken
- 250
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Live preview and test console
This is the real form. Answer it to test the 4 conditional rules — nothing is sent or stored.
Page 1 of 2 — About your use
3 questions are hidden by conditional logic right now — change an answer above to reveal them.
Works for you? Take Yusuf E.'s copy into your own workspace — questions, rules and settings included.
Who this template is for
Substance Use Screening Form is built for small teams who need a reliable intake process who need to collect the same complete information from everyone.
- Small teams who need a reliable intake process working in healthcare & clinical.
- Teams who need to collect the same complete information from everyone without writing code or paying for a custom build.
- Anyone replacing chasing missing details over email with one structured record per enquiry.
- Respondents are the people you send it to — the form asks them 14 questions across 2 screens.
- Mobile-heavy audiences, thanks to the one-question-per-screen card layout.
Why this form is useful
It removes the cost of chasing missing details over email and turns each submission into a record your team can act on immediately.
- 9 questions are required, so submissions arrive complete instead of needing a follow-up email.
- It pins the request to a specific date.
- Conditional logic hides 4 questions until they are relevant — shorter forms convert better than long ones.
- Splitting the form across 2 pages keeps each screen short and shows respondents how much is left.
- Every response is stored, searchable and exportable, so nothing depends on one person's inbox.
How to use this template
From copy to live form is a few minutes of work, and every step is reversible.
- 1Press “Use this template” — a fresh copy of Substance Use Screening Form lands in your workspace, ready to edit.
- 2Rename or delete any question, and change what is required. Nothing here is fixed.
- 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
- 4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
- 5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.
Logic and conditions blueprint
Exactly how this form behaves as it is answered — 4 conditional rules ship with it.
- Features advanced show logic: if “Do you currently use tobacco products?” is Yes, the form dynamically exposes “Which products, and how often?”. Otherwise that question never appears.
- Features advanced show logic: if “Do you drink alcohol?” is Yes, the form dynamically exposes “How often, and how much on a typical occasion?”. Otherwise that question never appears.
- Features advanced show logic: if “Do you use any recreational or non-prescribed drugs?” is Yes, the form dynamically exposes “Which substances, and how often?”. Otherwise that question never appears.
- Features advanced show logic: if “Has anyone expressed concern about your use of alcohol or other substances?” is Yes, the form dynamically exposes “Describe what was said”. Otherwise that question never appears.
- All 4 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.
What this form asks
Page 1 — About your use
- Patient full namerequired
- Date of birthrequired
- Date completedrequired
- Do you currently use tobacco products?required
- Which products, and how often?
- Do you drink alcohol?required
- How often, and how much on a typical occasion?
- Do you use any recreational or non-prescribed drugs?required
- Which substances, and how often?
Page 2 — Patterns and impact
- Has anyone expressed concern about your use of alcohol or other substances?required
- Describe what was said
- Have you ever tried to cut down or stop?required
- Do you use any of these substances to cope with stress, pain or sleep?required
- Anything else you want the care team to know
Conditional logic in this build
- When “Do you currently use tobacco products?” is Yes, show “Which products, and how often?”.
- When “Do you drink alcohol?” is Yes, show “How often, and how much on a typical occasion?”.
- When “Do you use any recreational or non-prescribed drugs?” is Yes, show “Which substances, and how often?”.
- When “Has anyone expressed concern about your use of alcohol or other substances?” is Yes, show “Describe what was said”.
Questions about this shared form
Does this form diagnose a substance use disorder?
No. It records what the patient reports; any diagnosis or clinical assessment is made separately by a qualified clinician, not by this form.
Is there a score at the end?
No. The form does not total, weight or grade the answers in any way; it is a plain written record for the clinician to read.
Can a patient decline to answer?
Yes, and the drug use question includes a 'prefer not to say' option for that reason; a declined answer is still a valid, recorded response.
Who should see these answers?
Limit access to the care team involved in the patient's treatment and handle the record with the same confidentiality as the rest of the chart.
Is the Substance Use Screening Form template free to use?
Yes. You can preview and test Substance Use Screening Form on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.
What does the Substance Use Screening Form template ask for?
It asks 14 questions across 2 pages, 9 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.
Can I edit the Substance Use Screening Form form after copying it?
Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.
How does the conditional logic in this healthcare & clinical form work?
4 conditional rules ship with the template: Features advanced show logic: if “Do you currently use tobacco products?” is Yes, the form dynamically exposes “Which products, and how often?”. Otherwise that question never appears. Features advanced show logic: if “Do you drink alcohol?” is Yes, the form dynamically exposes “How often, and how much on a typical occasion?”. Otherwise that question never appears. Features advanced show logic: if “Do you use any recreational or non-prescribed drugs?” is Yes, the form dynamically exposes “Which substances, and how often?”. Otherwise that question never appears. All rules are editable in the Logic tab.
Where do responses to the Substance Use Screening Form form go?
Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.
Can I embed the Substance Use Screening Form form on my own website?
Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.
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