Post-Treatment Survey
Thank you for receiving AcuDetox. This survey helps us evaluate the accessibility, usefulness, community impact, & improving future clinics. Your participation is voluntary. You may skip any question. Responses may be combined with responses from other participants for program evaluation, grant reporting, fundraising, & community impact reporting.
Name you go by:
First Name
Last Name
What clinic did you receive a treatment?
Is this your first AcuDetox treatment?
Yes
No, I have participated before.
If no, about how many AcuDetox treatments have you received?
2 - 5
6-9
10+
Would you participate in AcuDetox again?
Definitely
Maybe
No
Before your session
Rate how you felt immediately before today's session.
Stress
1
2
3
4
5
Not-stressed
Very stressed
1 is Not-stressed, 5 is Very stressed
Anxiety / Nervousness
1
2
3
4
5
No Anxiety
Lots of anxiety
1 is No Anxiety, 5 is Lots of anxiety
Physical tension
1
2
3
4
5
No tension
Lots of tension
1 is No tension, 5 is Lots of tension
Feeling emotionally overwhelmed
1
2
3
4
5
Not overwhelmed
Very Overwhelmed
1 is Not overwhelmed, 5 is Very Overwhelmed
Feeling grounded + present
1
2
3
4
5
Not grounded
Very grounded
1 is Not grounded, 5 is Very grounded
Overall feeling of well-being
1
2
3
4
5
Not well
Very well
1 is Not well, 5 is Very well
After your session
Rate how you feel right now.
Stress
1
2
3
4
5
Not-stressed
Very stressed
1 is Not-stressed, 5 is Very stressed
Anxiety / Nervousness
1
2
3
4
5
No Anxiety
Lots of anxiety
1 is No Anxiety, 5 is Lots of anxiety
Physical tension
1
2
3
4
5
No tension
Lots of tension
1 is No tension, 5 is Lots of tension
Feeling emotionally overwhelmed
1
2
3
4
5
Not overwhelmed
Very Overwhelmed
1 is Not overwhelmed, 5 is Very Overwhelmed
Feeling grounded + present
1
2
3
4
5
Not grounded
Very grounded
1 is Not grounded, 5 is Very grounded
Overall feeling of well-being
1
2
3
4
5
Not well
Very well
1 is Not well, 5 is Very well
After today's session, do you feel more able to regulate or settle your nervous system?
Significantly more able
Moderately more able
Slightly more able
No noticeable difference
Less able / more uncomfortable
What changes did you notice during or after the session? (Select all that apply)
Felt calmer
Felt more grounded
Felt safer or more settled in my body
Reduced physical tension
Reduced stress
Reduced anxiety or nervousness
Felt less emotionally overwhelmed
Felt more present
Felt sleepy or deeply relaxed
Experienced emotional release
Increased mental clarity
Felt an increased sense of wellbeing
Felt more connected to myself
Felt more connected to the people/community around me
No noticeable change
Experienced temporary discomfort
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Next
If AcuDetox were regularly available in your community, how often might you use it?
Weekly
Bi-Weekly
Monthly
Occasionally
During periods of increased stress
Probably wouldn't use it
Which best describes your current access to healthcare?
Private insurance
Employer sponsored insurance
Medicare
Medicaid
Uninsured
Prefer not to answer
How would you describe your current financial ability to access wellness or supportive services?
I can generally afford the services I need
Cost sometimes prevents me from accessing services
Cost frequently prevents me from accessing services
I generally cannot afford these services without free or subsidized options
Prefer not to answer
What barriers sometimes make wellness or supportive care difficult for you to access?
Cost
Lack of health insurance
Transportation
Scheduling / Work hours
Childcare / Caregiving responsibilities
Not knowing where to find services
Long waitlists
Previous negative experiences with healthcare or wellness providers
Services do not feel culturally relevant or welcoming
Disability or accessibility barriers
Concern about stigma or judgment
I generally do not experience barriers
What would make this service more accessible or useful to you & your community?
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Next
Where would you like to see AcuDetox offered?
What was the most helpful or meaningful part of your AcuDetox treatment?
In one or two sentences, how would you describe your AcuDetox experience to someone who has never tried it?
Any suggestions to make these clinics more accessible, helpful, or more pleasant to experience?
Rate your experience
1
2
3
4
5
Submit
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