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Questions marked with a * are required Exit Survey
 
 
* Have you ever used an opioid medication to get high?
 
Yes
 
No
 
Uncertain
 
 
 
* Have you or a member of your immediate family (father, mother, brother, sister) been prescribed an opioid medication during the past twelve months?
 
Yes
 
No
 
Uncertain
 
 
 
* Do you know someone who is using opioid medication to get high?
 
Yes
 
No
 
Uncertain
 
 
 
* Do you know someone who is using heroin or fentanyl to get high?
 
Yes
 
No
 
Uncertain
 
 
 
* Do you know anyone who has died from an overdose?
 
Yes
 
No
 
Uncertain
 
 
 
* Have you considered using either opioid medication or heroin to get high?
 
Yes
 
No
 
Uncertain
 
 
 
* After today’s presentation:
 
I am less likely to use opioid medication or heroin to get high.
 

I am more likely to use opioid medication or heroin to get high.

 
My intention to use is the same.
 
 
 
* What did you like best about today’s presentation?
   
 
 
 
* What did you like least about today’s presentation?
   
 
 
 
* What was missing from today’s presentation?
   
 
 
 
* What grade are you in?
 
 
 
* What is your gender?
 
Male
 
Female
 
 
 
* What is your ethnicity?
 
 
 
* May we contact you via email to provide information about our upcoming events? We value your input and promise that ALL information is strictly confidential and will not be shared.
 
Yes
 
No
 
 
 
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