4 and 4 of Recovery - Post Survey

All answers in this survey are kept confidential, please answer all questions as honestly as you can. We appreciate your feedback!

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* 1. Please enter your full name

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* 2. Please enter your email

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* 3. Phone Number

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* 4. Are you a cafe member?

Yes

No

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* 5. Do you plan to attend all four sessions of this workshop?

Yes

No

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* 6. On a scale of 1-5, how connected do you feel to your recovery community?

1 - Not at all

2 - Somewhat

3 - Neutral

4 - Connected

5 - Very connected

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* 7. On a scale of 1-5, how confident are you in your recovery skills? (stress/trigger management, coping skills, etc.)

1 - Not at all

2 - Somewhat

3 - Neutral

4 - Strong

5 - Very Strong

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* 8. On a scale of 1-5, rate your (current) desire to use illicit substances:

1 - Not at all

2 - Somewhat

3 - Neutral

4 - Strong

5 - Very Strong

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* 9. On a scale of 1-5, how desirable is achieving recovery to you?

1 - Not at all

2 - Somewhat

3 - Neutral

4 - Desirable

5 - Very Desirable