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Questionnaire template

Recovery Program Feedback

Gathers feedback from people in addiction recovery on early challenges, helpful program parts and confidence ahead.

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Healthcare · Alcohol assessment. All Healthcare templates

Questions in this template

Your Early Recovery

  1. Thank you for sharing your experience. Your answers help us improve the support our recovery program offers and are kept confidential.

  2. How long have you been continuously sober?

    Choose one:

    • Not currently sober
    • Less than 3 months
    • 3 to under 6 months
    • 6 to under 12 months
    • 1 year or more
    • Prefer not to say

  3. Thinking about your first weeks of recovery, how challenging was each of the following?

    • Handling cravings
    • Staying away from situations that tempted you
    • Managing emotional stress
    • Finding people who supported you

    For each row: choose one:

    • 1 - Not at all challenging
    • 2
    • 3
    • 4
    • 5 - Extremely challenging

Your Experience of the Program

  1. Which parts of the program have helped you? Select all that apply.

    Choose any that apply:

    • One-to-one counselling
    • Group therapy
    • Mindfulness activities
    • Fitness and wellbeing activities
    • My personal treatment plan
    • Other
    • None of these

  2. In what ways did the parts you selected support your recovery?

    Condition: Shown when at least one program part was selected

    Open answer

Looking Ahead

  1. How confident are you that you will stay sober over the coming months?

    Choose one:

    • Very confident
    • Fairly confident
    • Not very confident
    • Not at all confident

  2. What would help you feel more confident about staying sober? (optional)

    Open answer

  3. Would you be willing to take part in later surveys or conversations about how your recovery is going?

    Choose one:

    • Yes
    • No