• JACKSON-BIBBY AWARENESS GROUP

    DRINKING DRIVING PROGRAM, SAN BERNARDINO COUNTY

  • EXIT INTERVIEW

  • Today's Date*
     / /
  • Date of Last Drink*
     / /

  • Read the statement and check the answer that best fits you.

  • 1. Since Entering the DDP, my health has been*
  • 2 . Since Entering the DDP, my family life has been*
  • 3. Since Entering the DDP, my financial situation has been*

  • Check the answer that best fits you.

  • 4. I feel depressed or blue.*
  • 5. I have a sense of well being.*
  • 6. This program has helped me understand the effect of alcohol on my life.*
  • 7. This program is a waste of time.*
  • 8. The staff have treated me fairly.*
  • 9. I have a drinking problem.*
  • 10. As a result of participation in this program, my drinking has been*
  • 11. As a result of participation in this program, my drinking & driving has been…*

  • On submitting the form, the form(s) will be emailed directly to Jackson-Bibby.

  •  
  • Should be Empty: