Optional SBIRT Screening Opt Out
We know that, as your child’s caregiver, you desire the best resources for your child and other young people in our community. The Masconomet Youth Risk Behavior Survey data consistently demonstrates that a small number of our students try alcohol, marijuana and other drugs, and by the end of high school, many more students report substance use.

In order to help prevent students from starting to use substances, or intervene with early use, Masconomet nursing and counseling staff will be providing an interview-based screening called SBIRT (Screening, Brief Intervention, Referral to Treatment) for all 7th-grade students about the use of alcohol, marijuana and other drugs. The screening will be conducted during March of 2021.
Sign in to Google to save your progress. Learn more
Name of Adult Completing this Form *
Student First Name *
Student Last Name *
Screening Status *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Masconomet Regional School District. Report Abuse