We'd love your feedback | CJFHC Personal Concierge™

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Are you a:*

You selected "other", please describe:

Please indicate your level of agreement or disagreement with the following statements:*

	Strongly agree	Agree	Neutral	Disagree	Strongly disagree
I am confident of my ability to manage my everyday life
I am confident of my parenting skills
I am confident of my ability to manage substance abuse
I know the different medical treatment options for my substance abuse:
I can follow through on actions I need to do at home (i.e. housekeeping, paying bills on time, etc.):
I am the person who is responsible for managing my health.

Are you currently engaged in a substance abuse disorder treatment program?**

What is the name of your substance abuse disorder treatment program?*

What types of messages did you find most helpful about this program?*

(Please check all that apply)

What else did you find most helpful about the program?

Was the number of messages that you received:*

What would have made the program better?*

(Please check all that apply)

What other topics would have made the program better?*

What else would have made the program better?*

Overall, this program helped me to better manage my medications and take care of my baby.*

Comments*

Would you recommend this program to a friend?*

Refer a Friend

Know someone who might be interested in this program? Fill out the fields below to send them a link to sign up!

Friend's First Name

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