90 Day Survey Full Name(Required) Email address(Required) Dates of admission(Required) Are you active in your recovery at this time? Yes No Have you had any slips or relapses since discharge? Yes No If yes how long ago? How long did it last? In months, how long have you been abstinent from your drug of choice? Are you attending recovery meetings regularly? Yes No If yes, how many on average per week?0-23-56 or moreDo you have a sponsor? Yes No Are you and your sponsor formally working on the 12 steps together? Yes No If yes, how many times per week do you have contact?0-23-56 or moreUntitled Have you maintained regular contact with any of these individuals or providers? (check all that apply): Therapist/counselor Psychiatrist Recovery Coach Recovery Navigator Sober network Other alumni of JI ATR Mass Rehab What best describes your living situation? RRH supported sober living RRH supported apartment Sober living Home or apartment with self only Home or apartment with supportive others Home or apartment with others not supportive of recovery Are you employed or furthering your education? (check all that apply): Work Full-Time Work Part-Time School Full-Time School Part-Time None of the above What other activities do you engage in that support your recovery? (check all that apply): Exercise/gym Team Sports Meditation Yoga Volunteering Hiking Write/journal Sponsor others through a fellowship Other Are you attending Alumni Open Houses on the last Wednesday of the month at 5:30 pm? Yes No Would you like to receive Alumni Program updates and event reminders by email? Yes No Already receiving updates How would you rate your quality of life (i.e relationships, job satisfaction, sense of purpose etc.) today?On a scale of 1-10 with 10 being the highest and bestHow does that compare with 60 days ago?Somewhat improvedGreatly improvedSomewhat worsenedGreatly worsenedAbout the sameHow would you rate your sense of self-worth today?On a scale of 1-10 with 10 being the highest and bestHow does that compare with 60 days ago?Somewhat improvedGreatly improvedSomewhat worsenedGreatly worsenedAbout the samePlease write a brief testimonial we can use on our website and in our publications. Just tell us a little about how your life has improved, or what you have learned about yourself in recovery in the last 60 days. If we decide to share it we will only use first names.(Required)Please provide the address to send your gift to.Please allow 1-3 weeks to processAny ideas for alumni activities or events? We are open to suggestions!!EmailThis field is for validation purposes and should be left unchanged. Δ
