Cheektowaga PD Survey
***** Disclaimer: This is an anonymous survey, your answers will not affect your criminal case. *****
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Basic Demographics
Gender
Race
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Age
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Home ZIP Code
Screening Questions
Have you ever used drugs?
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What types of drugs have you used? (check all that apply)
When was the last time you used any of these substances?
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Is your arrest related to drug use?  (i.e. possession of drugs charge or drug use is an underlying reason for your arrest)
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Are you already linked with a treatment program for your substance use disorder?
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Would you like support in your drug use?
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This form was created inside of Abbey Mecca & Company.