4D Community Survey
This survey is intended for individuals in recovery who have used 4D in there recovery. Your identity will not be disclosed and we will never sell your email.
Email address *
About You
Self-identified race/ethnicity:
Check all that apply: *
How old are you? *
What is your gender identity? *
Do you identify as *
How much recovery time do you have *
What county do you live in? *
How far do you travel to come to 4D *
How do you get to 4D? Check all that apply. *
Do you have a drivers license? *
Do you work, go to school and/or volunteer check all that apply *
Have you ever wanted to get clean but could not get into treatment for any of the following reasons. (Check all that apply) If you never had a problem getting into services, check the last box. *
Do you feel you have been discriminated against or denied something because you are in recovery? *
What type of health insurance do you have? Oregon Health Plan is Also: "OHP," "ObamaCare and/or "Government/State Care." *
Have you ever used the following recovery services, check all that apply. *
What were your top 3 substances, or what were your 3 drugs of choice (doc) (check three) *
What type of recovery communities do you attend? *
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