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CAGE Alcohol Screening Questionnaire

Asks about date of screening, have you felt you should cut down on drinking, and have people annoyed you by criticizing your drinking. Built for primary care annual physicals and wellness visits.

Questions
12
Pages
2
Time
about 3 min
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Your practice

CAGE Alcohol Screening Questionnaire

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • Primary care annual physicals and wellness visits
  • Emergency department alcohol screening triage
  • Pre-surgical substance use risk assessment
  • Behavioral health intake and SBIRT workflows

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What's inside

Before you publish: Clinical review required: this worksheet does not calculate scores, diagnose, or recommend treatment. Confirm the questions and response options against your approved assessment protocol before use.

Page 1 · Your information

  1. Patient NameText · Required
  2. Date of BirthDate
  3. Date of ScreeningDate
  4. Have you felt you should Cut down on drinking?Multiple Choice · 3 choices
  5. Have people Annoyed you by criticizing your drinking?Long Text

Page 2 · Additional details

  1. Have you had a morning Eye-opener drink?Multiple Choice · 3 choices
  2. Current Drinking FrequencyLong Text
  3. CAGE Total ScoreNumber
  4. Clinical InterpretationLong Text
  5. Prior Alcohol Treatment HistoryLong Text

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the CAGE Alcohol Screening Questionnaire, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

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Questions

Formisoft provides secure form collection and a Business Associate Agreement (BAA). Your practice must review the form content, access permissions, and sharing workflow for its requirements.

Yes. You can add, remove, reorder, or reword any of the 12 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Patients open a secure link from an email, a text, or a QR code and complete the form on their phone, tablet, or computer before their appointment. No app download required.

Yes, on Front Desk. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Yes. The CAGE Alcohol Screening Questionnaire works on any device. Most patients complete intake forms on their phone, so every template is built for small screens first.

Send it before the visit, so patients arrive ready.

Add the CAGE Alcohol Screening Questionnaire to your account and make it yours in a few minutes.

Cancel anytime · BAA included

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