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Fulton County
Medication Disposal
Program Evaluation
THANK YOU
for disposing of your unused medication and helping to prevent substance use.
Please help us to improve our program by taking this brief survey.
*
1.
Did the pouch prompt you to clean out your medicine cabinet?
(Required.)
Yes, I do not clean out my medicine cabinet regularly.
No, I clean out my medicine cabinet on a regular basis.
No, I haven't used the pouch yet. (Please tell us why in the comments below.)
*
2.
Was the pouch easy to use?
(Required.)
Yes
No
N/A I haven't used the disposal pouch yet.
*
3.
What types of medication did you dispose of?
(Required.)
Over the counter (Tylenol, Advil, etc...)
Only
Narcotics/Opioids (OxyContin, Percocet, etc...)
Narcotics/Opioids (OxyContin etc)
PLUS
other medications
Other Prescription Medications (non-narcotic) (Xanax, Wellbutrin, Cialis, etc...)
Vitamins
Not Sure
*
4.
Where did you receive your medication disposal pouch?
(Required.)
Community Event
Road to Wellness Event
Police Department/Sheriff's Office
Retail Pharmacy
Hospital Pharmacy
Physician's Office
Health Department
*
5.
Did you know that Fulton County has several 24/7 drug collection boxes?
(Required.)
Yes
No
*
6.
What is your zip code?
(Required.)
This medication disposal program was developed in partnership with Healthy Choices Caring Community,
Summit County Community Partnership, and funded by Four County ADAMhs Board.
