Addiction Professional Survey
Answers marked with a * are required.
 
1. Which category best describes what you do? *
      

 
 
 
2. Do you ever refer patients/clients to inpatient chemical dependency treatment? *
      

 
 
 
3. Please check the box to indicate your level of familiarity with these inpatient treatment centers: *
  Not Familiar Familiar Very Familiar
Betty Ford Center
Caron Treatment Centers
Father Martin’s Ashley
Hanley Center
Hazelden
Marworth
Seabrook House
Sierra Tucson
Sundown M Ranch
Talbott Center
 
 
 
4. Please check the boxes next to the five (5) treatment attributes that are most important to you when referring: *
      
 
 
 
5. Please mark the boxes next to the three (3) issues that, in your opinion, are the most important issues facing the addiction counseling and treatment field today: *
      
 
 
 
6. Please mark the top three (3) in-patient treatment facilities to which you refer: *
      
 
 
 
7. Please mark the top three (3) programs or types of treatment support you would like to see more inpatient treatment centers provide: *
      
 
 
 
 
 

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