CAGE FORMCJHTadmin2024-03-07T10:11:16+00:00 "*" indicates required fields The CAGE acronym represents keywords present in each question. It stands for: 1. Cut 2. Annoyed 3. Guilty 4. Eye The questions represented by the CAGE acronym are: 1. Have you ever felt you should “cut” down on your substance use?* Yes No 2. Have people “annoyed” you by criticizing your substance use?* Yes No 3. Have you felt bad or “guilty” about your substance use?* Yes No 4. Have you ever used a substance first thing in the morning to steady your nerves or start the day (an “eye” opener)?* Yes No Your answers will indicate a possible substance abuse problem. Typically, answering “yes” to two or more questions suggests you may have a substance dependency.DISCLAIMER: By typing your name below,you are signing this form electronically. You agree that your electronic signature is the legal euivalent of your manual signature on this document.Todays Date MM slash DD slash YYYY Clients Name(Please Print)*
