Firestrong 30 Day Trial

Home

Please fill out the form below. An email will follow with more specific details on what the membership includes.

First Name

Last Name

Phone Number

Department Name

Address

City

State

Zip

Total Employees
1-100
100 - 300
300 - 500
500 - 1000
1000 -2000
2000+

FIRESTRONG Membership includes:

Personalized web page specific for your members
Peer Support Team page with personalized biography and contact information
Secured log-in for your members to gain access to a variety of personalized tools including testimonials, peer support team network and resource pages
Access to professional counselors through the Fire Crisis Network Line: 844.525.FIRE (3473) (they are trained on your resources and handle most calls over the phone, they will connect member to your local crisis network if there is a need)
Updated general mental health information, assessments and financial fitness programs and resources
Train-the-Trainer for a Suicide Awareness Resource Training presentation
Mental Health professional available for consultation and questions

1. In the past 4 weeks, about how often did you feel tired out for no good reason?
	None of the time
	A little of the time
	Some of the time
	Most of the time
	All of the time

2. In the past 4 weeks, about how often did you feel nervous?
	None of the time
	A little of the time
	Some of the time
	Most of the time
	All of the time

3. In the past 4 weeks, about how often did you feel so nervous that nothing could calm you down?
	None of the time
	A little of the time
	Some of the time
	Most of the time
	All of the time

4. In the past 4 weeks, about how often did you feel hopeless?
	None of the time
	A little of the time
	Some of the time
	Most of the time
	All of the time

5. In the past 4 weeks, about how often did you feel restless or fidgety?
	None of the time
	A little of the time
	Some of the time
	Most of the time
	All of the time

1. Do you feel you are a normal drinker? ("normal" - drink as much or less than most other people)?
	No
	Yes

2. Have you ever awakened the morning after some drinking the night before and found that you could not remember a part of the evening?
	No
	Yes

3. Does any near relative or close friend ever worry or complain about your drinking?
	No
	Yes

4. Can you stop drinking without difficulty after one or two drinks?
	No
	Yes

6. Have you ever attended a meeting of Alcoholics Anonymous (AA)?
	No
	Yes

7. Have you ever gotten into physical fights when drinking?
	No
	Yes

8. Has drinking ever created problems between you and a near relative or close friend?
	No
	Yes

9. Has any family member or close friend gone to anyone for help about your drinking?
	No
	Yes

10. Have you ever lost friends because of your drinking?
	No
	Yes

11. Have you ever gotten into trouble at work because of drinking?
	No
	Yes

14. Do you drink before noon fairly often?
	No
	Yes

15. Have you ever been told you have liver trouble such as cirrhosis?
	No
	Yes

16. After heavy drinking have you ever had delirium tremens (D.T.?s), severe shaking, visual or auditory (hearing) hallucinations?
	No
	Yes

19. Has your drinking ever resulted in your being hospitalized in a psychiatric ward?
	No
	Yes

13. Have you ever neglected your obligations, your family, or your work for two or more days in a row because you were drinking?
	No
	Yes

17. Have you ever gone to anyone for help about your drinking?
	No
	Yes

18. Have you ever been hospitalized because of drinking?
	No
	Yes

20. Have you ever gone to any doctor, social worker, clergyman or mental health clinic for help with any emotional problem in which drinking was part of the problem?
	No
	Yes

21. Have you been arrested more than once for driving under the influence of alcohol?
	No
	Yes

22. Have you ever been arrested, even for a few hours, because of other behavior while drinking?
	No
	Yes

1. Have you ever felt you should cut down on your drinking?
	No
	Yes

2. Have people annoyed you by criticizing your drinking?
	No
	Yes

3. Have you ever felt bad or guilty about your drinking?
	No
	Yes

4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?
	No
	Yes

Firestrong 30 Day Trial

Department Information

FIRESTRONG Membership includes:

Alcohol Assessment

Alcohol Dependence Assessment

Anxiety & Distress Assessment

Depression Assessment

Drug Abuse Assessment

PTSD Assessment

6. In the past 4 weeks, about how often did you feel so restless you could not sit still?
	None of the time
	A little of the time
	Some of the time
	Most of the time
	All of the time

7. In the past 4 weeks, about how often did you feel depressed?
	None of the time
	A little of the time
	Some of the time
	Most of the time
	All of the time

8. In the past 4 weeks, about how often did you feel that everything was an effort?
	None of the time
	A little of the time
	Some of the time
	Most of the time
	All of the time

9. In the past 4 weeks, about how often did you feel so sad that nothing could cheer you up?
	None of the time
	A little of the time
	Some of the time
	Most of the time
	All of the time

10. In the past 4 weeks, about how often did you feel worthless?
	None of the time
	A little of the time
	Some of the time
	Most of the time
	All of the time

1. I was bothered by things that don't usually bother me.
	Rarely or none of the time (<1 day)
	Some or a little of the time (1-2 days)
	Occasionally or a moderate amount of the time (3-4 days)
	Most or all of the time (5-7 days)

2. I did not feel like eating; my appetite was poor.
	Rarely or none of the time (<1 day)
	Some or a little of the time (1-2 days)
	Occasionally or a moderate amount of the time (3-4 days)
	Most or all of the time (5-7 days)

3. I felt that I could not shake off the blues even with the help of my family or friends.
	Rarely or none of the time (<1 day)
	Some or a little of the time (1-2 days)
	Occasionally or a moderate amount of the time (3-4 days)
	Most or all of the time (5-7 days)

4. I felt that I was just as good as other people.
	Rarely or none of the time (<1 day)
	Some or a little of the time (1-2 days)
	Occasionally or a moderate amount of the time (3-4 days)
	Most or all of the time (5-7 days)

5. I had trouble keeping my mind on what I was doing.
	Rarely or none of the time (<1 day)
	Some or a little of the time (1-2 days)
	Occasionally or a moderate amount of the time (3-4 days)
	Most or all of the time (5-7 days)