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- What is your gender identity?
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- How would you describe the area where you live?
- What is your current employment status?
- What is the highest level of education you have completed?
- What is your gross annual household income?
- What is your current health insurance status?
- If insured, what type of insurance do you have?
- What is your relationship to substance use disorder? (Check all that apply)
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- In the past 12 months, have you or someone you know attempted to access substance use disorder treatment services in West Virginia?
- What are the primary barriers in your community to accessing treatment and/or recovery services?
- Are there specific populations in your community who face greater difficulty accessing SUD treatment and/or recovery services? (Select all that apply)
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- In your opinion, which ONE area requires the most urgent improvement or investment in your community?
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- Do you currently work for an organization that provides SUD treatment or recovery support services?
- What type of organization do you work for?
- What population(s) does your organization primarily serve? (Check all that apply)
- What is the greatest operational challenge your organization faces in providing SUD services?
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- May we contact you for clarification or follow-up regarding your responses?
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Format: (000) 000-0000.
- Preferred contact method
- Would you like to be entered into the prize drawing for one of two $50 gift cards?
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