Health & Wellness Survey

1. How satisfied are you with the conditions of your living space?
2. During the past 30 days how stressful have things been for you because of your use of alcohol or other drugs?
3. During the past 30 days, has your use of alcohol or other drugs caused you to reduce or give up important activities?
4. During the past 30 days, has your use of alcohol or other drugs caused you to have emotional problems?
5. Have you enough money to meet your needs?
6. How would you rate your overall health right now?
7. How would you rate your quality of life?
8. How satisfied are you with your health?
9. Do you have enough energy for everyday life?
10. How satisfied are you with your ability to perform your daily activities?
11. How satisfied are you with yourself?
12. How much have you been bothered by psychological or emotional problems in the past 30 days?
13. In the past 30 days, did you have interactions with family and/or friends that are supportive of your recovery?
14. To whom do you turn when you are having trouble? Select only ONE.
15. How satisfied are you with your personal relationships?