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Write a description of your survey here. Select any question below to change it. Then add questions as needed.

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* 1. What is your current age?

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* 2. What is your ethnicity?

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* 3. What is your drug of choice?

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* 4. At what facility did you last receive treatment?

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* 5. Are you currently in a 12 step program (AA/NA)?

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* 6. In what area of Cape Cod do you reside?

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* 7. What is your current housing situation?

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* 8. What is your current employment situation?

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* 9. Is transportation an issue for you receiving help?

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* 10. What type of insurance do you have?

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* 11. Do you have a Primary Care Physician on Cape Cod?

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* 12. Do you have a mental or behavioral therapist on Cape Cod?

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* 13. If you answered “yes” to Question 12, how often do you see your therapist?

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* 14. Do you suffer from any of the following mental health issues? (Check all that apply)

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* 15. Have you experienced sexual assault or related trauma?

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* 16. Have you experienced physical or emotional abuse?

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* 17. Has RWW holistic healing practices(acupuncture, meditation, yoga, breath work etc) worked to support your physical and mental health?

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* 18. Which areas would you like to have more assistance with? (Check all that apply)

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* 19. Do you need financial assistance in receiving therapy?

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* 20. Would you like to learn about investing money for the future?

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* 21. Are you receiving services from the following ? (check all that apply)

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