Baseline Survey of the Community

The following survey will help the Lackawanna Opioid Coalition understand the type and amount of stigma currently residing in the attitudes and behaviors of members in our community.  Your answers from this survey will be kept confidential and will only be reported as a group.  The answers will indicate the type of training and education that will best reduce present stigma relating to opioid use disorder and overdoses amongst the community

Demographics

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* 1. Please indicate the date of survey:

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* 2. Please indicate your age:

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* 3. Please indicate your gender:

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* 4. Please indicate your race:

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* 5. Please indicate your highest completed level of education:

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* 6. Please indicate if you currently have or previously had a substance use disorder:

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* 7. Please indicate if someone you know currently has or previously had a substance use disorder:

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* 8. Please indicate your occupation:

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* 9. Please indicate your zip code of residence:

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