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* 1. First name:

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* 2. First name sharing:

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* 3. Email:

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* 4. Phone Number:

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* 5. PCM can contact me if they have any questions (*Please note that contact information is for PCM use only, and this information will not be shared publicly)

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* 6. Can you tell us about your lived experience with your mental health/addiction challenges?

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* 7. What motivated you to decide to make a change towards wellness/recovery?

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* 8. How did you begin to make changes?

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* 9. Can you talk about resources or coping skills that work for you and your mental health?

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* 10. What does your support system look like? (Personal/professional/community supports)

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* 11. How do you maintain your wellness/recovery?

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* 12. How have the changes you've made impacted your life?

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* 13. Is there anything else you would like to share?

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* 14. By submitting answers to this survey, I consent to share my recovery story on PCM’s social media, in PCM blogs, on PCM’s website, and/or in PCM’s newsletter. I acknowledge that PCM is committed to protecting and respecting my privacy. I understand that if I would like to remain anonymous, PCM will protect my identity. I understand that pieces of my recovery story will be used as quotes, and PCM may not use every answer for each question in this survey.

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