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Tracy’s House Alumni Follow-Up Survey
Welcome to My Survey
Thank you for taking a few minutes to complete this confidential survey. Your feedback helps us evaluate and improve services at Tracy’s House.
1.
Are you currently receiving Medication-Assisted Treatment (MAT)?
Yes
No
2.
Have you been diagnosed with Opioid Use Disorder (OUD)?
Yes
No
3.
Have you ever experienced an overdose?
Yes
No
4.
What was the source of your referral to treatment?
Legal System
Medical Provider
Self-Referral
Other (please specify)
5.
What was your primary drug of choice?
6.
How much clean time do you currently have?
0 - 6 months
6 months - 1 year
1 year - 2 years
Over 2 years
7.
How much clean time have you had after leaving Tracy's House
0 - 6 months
6 months - 1 year
1 year - 2 years
Over 2 years
8.
Did you complete Tracy’s House Intensive Outpatient Program (IOP)?
Yes
No
9.
Did you complete Tracy’s House Outpatient Program (OP)?
Yes
No
10.
After treatment, did you reside in Tracy’s Community Housing?
Yes
No
11.
Did you complete a detox program before entering Tracy’s House?
Yes
No
12.
Did you find employment while at Tracy’s House?
Yes
No
13.
Have you pursued further education since entering treatment?
Yes
No
Not yet, but I plan to
14.
Did you reunite with family or children after completing treatment?
Yes
No
Still working on it
15.
Did you take care of legal issues while at Tracy’s House?
N/A
Yes
No
Partially
16.
Rate your overall experience at Tracy's House (1 star being the lowest and 5 stars being the highest)
1 star
1 star
2 stars
2 stars
3 stars
3 stars
4 stars
4 stars
5 stars
5 stars
17.
Please describe your overall experience at Tracy's House
18.
Please share how Tracy's House may improve upon its services