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Project YOUR Screening Co-Hort 2
7 / 1
700%
*
1.
Name
(Required.)
*
2.
Phone
(Required.)
*
3.
Email
(Required.)
*
4.
What school do you attend ?
(Required.)
*
5.
Age
(Required.)
14
15
16
17
18
*
6.
How much do you know about
Fentanyl
?
(Required.)
A great deal
A lot
A moderate amount
A little
None at all
*
7.
How much do you know about
Narcan
?
(Required.)
A great deal
A lot
A moderate amount
A little
None at all
*
8.
Do you know someone who has ever overdosed?
(Required.)
Yes
No
*
9.
Have you lost someone to an overdose?
(Required.)
Yes
No
*
10.
Have you ever been exposed to drugs that were not prescribed to you?
(Required.)
Yes
No
*
11.
Have you ever taken prescribed medications, but not as directed?
(Required.)
Yes
No
*
12.
Have you ever been peer pressured into using drugs?
(Required.)
Yes
No
*
13.
Have you ever been to a party where drugs were being used recreationally?
(Required.)
Yes
No
*
14.
Are you comfortable speaking to your peers about drugs?
(Required.)
Yes
No
*
15.
If you have used drugs, do you share them with your peers?
(Required.)
Yes
No
*
16.
Would you like to know more about overdose prevention?
(Required.)
Yes
No
*
17.
We're looking for participants who can meet a few times a month to learn about overdose prevention. Would you be available to do this? Transportation, food, and a stipend are provided.
(Required.)
Yes
No
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