2021 Adult Follow-Up Survey |
BACKGROUND INFORMATION
This questionnaire asks questions about your background, drug and/or alcohol use, medical status, employment, legal status and family relationships. It should only take about 10 minutes. Your answers are completely CONFIDENTIAL and will help us continue to improve our services and provide our patients with the best care possible. Please answer each question as accurately as you can. Fill in the blanks or place a check mark in the appropriate box. Thank you.