Copyrights & Permissions Request Form

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Last Name

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Optional: Address (Floor, Building, Apt)

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If other, please specify

If no, how are you/your organization currently supporting implementation of The ASAM Criteria? [Please check all that apply]

I/we use the ASAM CONTINUUM™ software to assess patients and determine their treatment needs

I/we use ASAM CO-Triage™ to guide treatment referrals

I/we have obtained an ASAM Level of Care Certification from CARF International

I/we have completed an 8-hour training course on The ASAM Criteria from an endorsed training company

None of the above

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