If you would like to help BCR out by gathering some information please answer the following questions. All answers are submitted anonymously.
Do you work in the food/beverage/service industry? Please list what you do in the other space.
No
Yes currently do
Yes have in the past
Other:
Age
16-20
21-25
26-30
31-40
Over 40
Prefer not to answer
Other:
Clear selection
Gender Identity
Your answer
When was the last time you consumed alcohol?
Today
Yesterday
Last Week
Last Month
Over a Month Ago
Other:
Clear selection
When was the last time you consumed a recreational drug?
Today
Yesterday
Last Week
Last Month
Over a Month Ago
Other:
Clear selection
Have You Ever
Yes
No
Maybe
Do not remember
Prefer not to answer
Wondered if you have an alcohol/drug problem?
Been told by friends/family/coworkers you have an alcohol/drug problem?
Attended a recover meeting?
Gotten into legal trouble becasue of your alcohol/drug use?
Blacked out?
Had a sexual experience you don't remember?
Yes
No
Maybe
Do not remember
Prefer not to answer
Wondered if you have an alcohol/drug problem?
Been told by friends/family/coworkers you have an alcohol/drug problem?
Attended a recover meeting?
Gotten into legal trouble becasue of your alcohol/drug use?
Blacked out?
Had a sexual experience you don't remember?
Clear selection
If you have ever attended a recovery meeting please answer the following. What type of meetings have you attended? (Check all that apply)
AA
Life Ring
Smart Recovery
Refuge Recovery
Zen Buddhist Recovery Meeting
NA
Other:
If you have ever attended a recovery meeting please answer the following. Where did you attend the meetings? (Check all that apply)
Alano Club
Church
Personal Residence
Online
Other:
If you have ever attended a recovery meeting please answer the following. (Check all that apply, use the other to add your own responses)
Felt like you were welcomed
Felt like the meeting helped and you would go back
Would go back but to another meetings
Felt like the meeting did not help and turned you off from recovery
Wished there were people your age
Wished there were more people in the same job field as you
Other:
If you said you worked in a job that involved serving or selling alcohol how did the group respond?
Your answer
Have you ever considered rehab (in/out patient, detox, etc)
Yes
No
Clear selection
Did you go?
Yes
No
Clear selection
If you said no what was the reason why?
Money (could not afford)
Work (could not get time off work/afford to take time off work)
Other:
Have you ever attended therapy?
No
Yes in the past
I currently do
Other:
Clear selection
If you have not/have quit why?
Never interested me
I did not like my therapist
I could no longer afford to go
Other:
If you could get one thing out of the recovery community what would it be?
Your answer
What is one thing you think needs to be addressed in the recovery community?
Your answer
If BCR could do one thing better what would it be?
Your answer
If BCR could do one thing to help you personally what would it be?
Your answer
WHere would be the ideal place for you to attend a recovery meeting?
Your answer
Any other thoughts you have.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
