Family Task Force - Family Crisis Tool Kit Survey

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1. Please provide your zip code. *

2. Please select your age. *

under 18

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 or older

Refused or unknown

3. You received or purchased this Family Crisis Tool Kit to help a Loved One who is... *

A person you believe is at risk of misusing substances

An active substance user

A person in recovery from substance use

4. How many times has your Loved One experienced and opioid overdose? *

1-3 times

4-6 times

7 or more times

unknown

5. Which of these items in the Family Crisis Toolkit do you think will be most helpful to you and/or your Loved One? *

Narcan

13 Panel Drug Test

Membership to Allies in Recovery (AiR website)

Framework

Deterra deactivation kit (charcoal)

Required

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