Please take a few minutes to fill out the questions below. The information obtained in this assessment will help us to decide any health care services you may benefit from. We will also work with you to develop a plan of care as needed. All information will be kept private as required by state and federal law except in cases of mandated reporting. Your information may be shared with your doctors and service providers. This will help in providing appropriate care to you. Except as required by law, you have the right to agree or decline that this information be shared.