CAGE Alcohol Screening Questionnaire
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CAGE Alcohol Screening Questionnaire
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The CAGE Alcohol Screening Questionnaire implements the widely recognized four-question screening tool for identifying potential alcohol problems. The acronym CAGE stands for Cut down, Annoyed, Guilty, and Eye-opener -- four clinically validated questions that assess whether a patient has felt the need to cut down on drinking, been annoyed by criticism of their drinking, felt guilty about drinking, or used alcohol as a morning eye-opener. A score of two or more positive responses is considered clinically significant and warrants further evaluation.
This digital version preserves the brevity and simplicity that make the CAGE questionnaire one of the most frequently used alcohol screening instruments worldwide. The form captures patient demographics, administers the four core CAGE questions using clear yes/no response options, calculates the total score, and provides clinical interpretation guidance. Supplementary questions gather context on current drinking patterns, frequency, and any prior treatment history to give providers a more complete clinical picture.
The CAGE questionnaire is particularly effective in primary care annual physicals, pre-surgical assessments, emergency department triage, and behavioral health intake. While briefer than the full AUDIT, the CAGE has demonstrated high sensitivity for detecting alcohol dependence and is recommended by NIAAA and numerous medical specialty societies. This template supports SBIRT workflows and can be paired with more comprehensive tools when positive results require deeper evaluation.
What's included
- All four validated CAGE screening questions
- Automatic score calculation and clinical interpretation
- Current drinking frequency and pattern assessment
- Prior treatment history documentation
- SBIRT-aligned clinical recommendations
- Provider notes and follow-up action section
Who uses this template
- Primary care annual physicals and wellness visits
- Emergency department alcohol screening triage
- Pre-surgical substance use risk assessment
- Behavioral health intake and SBIRT workflows
All form fields
12 fields across 1 page. Customize any field after signing up.
How to use the CAGE Alcohol Screening Questionnaire
Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the CAGE Alcohol Screening Questionnaire from the template library. The form is ready to use immediately, but you can customize every field, add your practice logo, and adjust the layout to match your workflow.
Setup steps
- 1Choose the template. Find the CAGE Alcohol Screening Questionnaire in the template library and click “Use this template” to add it to your account.
- 2Customize fields. Add, remove, or reorder any of the 12 fields. Set fields as required or optional based on your practice needs.
- 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
- 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
- 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.
Frequently asked questions
Is the CAGE Alcohol Screening Questionnaire HIPAA compliant?
Yes. All Formisoft templates, including the CAGE Alcohol Screening Questionnaire, are HIPAA compliant. Data is encrypted with 256-bit AES at rest and TLS 1.3 in transit. A Business Associate Agreement (BAA) is included on every plan.
Can I customize the fields in this template?
Absolutely. You can add, remove, reorder, or modify any of the 12 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.
How do patients fill out this form?
Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.
Can I send this form automatically before appointments?
Yes. Formisoft's workflow automation can send intake forms automatically when an appointment is booked. You can set the timing (e.g., 48 hours before the visit) and include reminders for patients who haven't completed it.
Does this template work on mobile devices?
Yes. The CAGE Alcohol Screening Questionnaire is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.
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