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Provive Alumni Follow Up Survey
1.
How active have you been in your recovery process since completing treatment?
Very Active
Moderately Active
Somewhat Active
Not Active
Not Applicable
2.
How would you rate your quality of life currently?
1 star
2 stars
3 stars
4 stars
5 stars
3.
How would you rate your quality of life prior to coming to Provive Wellness?
1 star
2 stars
3 stars
4 stars
5 stars
4.
How would you rate your self worth currently?
1 star
2 stars
3 stars
4 stars
5 stars
5.
How would you rate your self worth prior to coming to Provive Wellness?
1 star
2 stars
3 stars
4 stars
5 stars
6.
How would you rate your mental health currently?
1 star
2 stars
3 stars
4 stars
5 stars
7.
How would you rate your mental health prior to coming to Provive Wellness?
1 star
2 stars
3 stars
4 stars
5 stars
8.
Are you experiencing any mental health issues currently?
Yes
No
9.
Have you experienced any relapses or slips?
Yes
No
Not Applicable
10.
If you answered yes to either of the last questions would you like Provive staff to reach out for support?
Yes
No
Not Applicable
11.
If you answered yes to the last question please let us know your name & a good contact number.
12.
Are you attending any support groups? (12 step, Dharma, Double Trouble, etc.) Select all that apply
Yes, regularly
Yes, occasionally
No, but I plan to
No
13.
On average, how many support group meetings do you attend per week?
None
1-2
3-4
5 or more
14.
Do you have a sponsor or certified peer support?
Yes
No
15.
How often are you in contact with your sponsor or peer support weekly?
None
1-2
3-4
5 or more times
16.
Are you working currently?
Yes
No
17.
Were you working prior to coming to Provive Wellness?
Yes
No
18.
How long were you in treatment with Provive Wellness?
Less than 1 month
1-3 months
3-6 months
More than 6 months
19.
Did you complete the program at Provive Wellness?
Yes
No
20.
Have you attended a Provive Alumni meeting or event?
Yes
No
21.
Have you received treatment after your time at Provive Wellness?
Yes
No
22.
Are there any staff you would like to give a shoutout or special recognition?
23.
Are there any ongoing services now that you've completed treatment that would be helpful?
24.
Any additional comments or suggestions?
