Substance Abuse Recovery Shelter Exit Survey
Basic Information
Name
Date of Exit
Age
Program Experience
How long did you stay at the shelter?
How helpful was the shelter in your recovery?
Very Helpful
Helpful
Neutral
Not Helpful
Not at all
What services did you use? (Select all that apply)
Counseling
Group Therapy
Medical Support
Employment Support
Other
Other services used
Outcomes
How confident are you in maintaining recovery after leaving?
Very Confident
Somewhat Confident
Neutral
Not Confident
Do you have stable housing after leaving?
Yes
No
Feedback
What did you like most about the shelter?
What could be improved?
Additional Comments