Step 1 of 2 - Before Group 50% Group/Event AttendanceSite*Serenity House of FlintWould you like to remain anonymous?*YesNoAre you an existing participant?*YesNoPlease enter your participant short code*Your participant short code is your first initial, last initial, birth month, day and year in the following format: FL02011901 Where First Last's birth date is 2/1/1901.How did you hear about us?*TreatmentHealthCareCriminal Justice SystemPeerCommunity AgencyFriend/FamilyFirst Name*Last Name*Phone*If you don't have a current phone number, please input "No phone".Email* If you don't have an email address, please input "no@email.com".Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Birth Date* Date Format: MM slash DD slash YYYY Gender*MaleFemaleTransgenderOtherNonbinaryPrefer not to answerRace*WhiteHispanic, Latin, or Spanish OriginBlack or African AmericanMiddle Eastern or North AfricanAmerican Indian or Alaska NativeNative Hawaiian or Pacific IslanderAsianMore than one raceOtherAre you receiving government assistance like medicaid, medicare, SNAP, etc?*YesNoAre you a person in recovery?*YesNoHow long have you been in recovery?* Date Format: MM slash DD slash YYYY What event are you attending?*Awareness eventSUD ConferenceDrumming CircleHolistic Healing Hour: Acudetox & AromatherapyHolistic Healing Hour: Recovery Reiki (r) and Talking CircleCommunity AcupuncturePAC time Yoga classRecovery Reiki TrainingAdolescent Holistic Healing HourOnline workshopOtherSUD Conference Session*One-on-one EFT sessionOne-on-one Reiki & Meditation sessionOne-on-one Naturopathy ConsultationRecovery Reiki GroupHealing EFT WorkshopOther Meeting Type*As a result of the Covid-19 have you returned back to active use?*YesNoIf your in active use of substances during the Covid-19, has your substance use...*increaseddecreasedstayed the samedoes not applyPre-session QuestionsHow would you rate the physical pain in your body?*NoneLowModerateHighWorst PossibleWhat is your level of anxiety?*NoneLowModerateHighWorst PossibleWhat is your level of stress?*NoneLowModerateHighWorst PossibleWhat is the level of anger you feel?*NoneLowModerateHighWorst PossibleHow would you rate your overall wellness?*Worst PossibleLowModerateGoodExcellent Post-session QuestionsHow would you rate the physical pain in your body?*NoneLowModerateHighWorst PossibleWhat is your level of anxiety?*NoneLowModerateHighWorst PossibleWhat is your level of stress?*NoneLowModerateHighWorst PossibleWhat is the level of anger you feel?*NoneLowModerateHighWorst PossibleHow would you rate your overall wellness?*Worst PossibleLowModerateGoodExcellent
