Benzodiazepine Survey Eight - Decided not to Withdraw
Answers marked with a * are required.
1. Benzodiazepine Survey Eight - Decided not to Withdraw
  The purpose of this survey is to collect statistical information from people who have decided not to withdraw from benzodiazepines or Z-drugs in the immediate future. Please complete this survey if you fall into this group.
 
1. What benzodiazepines or Z-drugs are you  currently taking? *

























       		 
 
 
2. How long have you been taking benzodiazepines or Z-drugs? *












      
 
 
 
3. If you are only taking one benzodiazepine or Z-drug, please enter the number of milligrams per day you are taking.
 
 
 
4. If you are taking more than one benzodiazepine or Z-drug at this time, enter the name of each drug that you are taking, followed by the number of milligrams you are taking, e.g. Valium 30, Klonopin 2.
 
 
 
5. Why were you prescribed benzodiazepines or Z-drugs? *





       		 
 
 
 
 

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