CHOICES RECOVERY SERVICES
Survey for Past Residents
Questions for improving Choices - your help is appreciated and will be used to better everyone's stay at Choices.
This survey is completely confidential. The group results will be shared.

FIRST NAME:                AGE:

MENTAL HEALTH DIAGNOSIS:

DRUG OF CHOICE:

WHAT DID YOU LIKE ABOUT CHOICES?

WHAT DID YOU DISLIKE ABOUT CHOICES AND WOULD LIKE TO SEE CHANGE?

HOW LONG WERE YOU AT CHOICES?

IN WHAT HOUSE WERE YOU LIVING?

SINCE LEAVING CHOICES, ARE YOU DOING BETTER OR WORSE?         Better    Worse

MORE DEPRESSED?                                                                                                      Yes          No

HAVE YOU BEEN TO THE HOSPITAL LESS?                                                             Yes         No

HAVE YOU BEEN HOMELESS LESS?                                                                           Yes        No

DO YOU EAT BETTER?                                                                                                     Yes       No

ARE YOU TAKING MEDICATION ON A BETTER SCHEDULE?                               Yes       No

DID YOU LIKE THE GROUPS AND ACTIVITIES AT CHOICES?                              Yes       No

DO YOU HAVE MORE ENERGY NOW?                                                                         Yes       No

ARE YOU EXERCISING/WALKING/BIKING MORE?                                                   Yes       No

ARE YOU BETTER NOW THAN BEFORE LEAVING CHOICES?                              Yes       No

HOW LONG HAVE YOU BEEN SOBER?        

DO YOU FEEL THAT THINGS ARE GETTING BETTER?                                             Yes      No

ARE YOU DRINKING/USING LESS?                                                                                 Yes      No

THANK YOU ONCE AGAIN FOR PARTICIPATING, YOUR INPUT IS VALUABLE AND NEEDED.

ANY COMMENTS?