Public form · private recordsNeed assistance?
Confidential whole-person assessment

Tell us what support you need

Complete one guided biopsychosocial and substance-use assessment. Your answers are reviewed privately by 2 Steps Away and are not published or displayed as clinical results.

27% core completion
11 core items remaining
Public assessment, private data: anyone may open this form, but submissions are written to a restricted 2 Steps Away Google Workspace record. This site does not display assessment results, other submissions, or the private clinical analysis.
Before you begin

Consent, privacy & PHI notice

Please review these notices before providing protected health information. You may pause, decline an optional question, or contact 2 Steps Away for assistance.

This form is not an emergency service.For immediate danger, suspected overdose, or a medical emergency, call 911. For suicide or mental-health crisis support in the U.S., call or text 988.

Who is completing this assessment?

If you are completing this for another person, you must have appropriate legal authority or permission.

HIPAA / PHI SUMMARY NOTICE

Your information. Your rights. Our responsibilities.

Effective August 20, 2026 · Summary notice for 2 Steps Away, Inc.

Your rights

  • Request access to or a copy of your health information.
  • Ask to correct information you believe is inaccurate.
  • Request confidential communications or certain restrictions.
  • Receive an accounting of certain disclosures and a copy of the full notice.
  • Choose someone to act for you and complain without retaliation.

How information may be used

  • To provide and coordinate treatment, support payment, and operate services as permitted by law.
  • To address a serious and imminent safety threat, comply with mandatory reporting, or meet other legal duties.
  • For other purposes only when permitted by law or authorized by you in writing.
  • Psychotherapy notes and SUD counseling notes receive additional protections.

Our responsibilities

  • Protect the privacy and security of PHI and limit access to authorized personnel.
  • Notify affected individuals after a breach when required.
  • Follow the privacy practices in the current notice and provide a copy on request.
  • Apply 42 CFR Part 2 protections when the program and records are covered.
Privacy contact: Privacy Officer, 2 Steps Away, Inc.info@2stepsaway.orgView website privacy policy

Required acknowledgments

The client may ask questions and may request a paper or accessible-format copy.

Optional communication and service permissions

These choices are separate from consent to assessment. Declining them does not by itself prevent assessment services.

Approved communication channelsSelect all that apply.

Optional 42 CFR Part 2 release of information

Use only when a covered SUD program needs a written consent to disclose Part 2 records. This permission is separate, specific, and revocable. Do not combine it with a legal-proceeding request or release of separately maintained SUD counseling notes.

No Part 2 disclosure is authorized through this assessment.
Section 1 of 7