Adolescent Residential Follow

Kairos Healthcare Inc

Adolescent Residential Follow-Up Survey (30 Day)

Client:

Date:

1. Of the past 30 days how many days have you NOT used any substances?

2. Of the past 30 days, how many have you attended school?

of days attended

3. In the past 30 days have you been arrested or put in detention?

Yes or No

If Yes, For what were you arrested?

4. Have you attended all scheduled appointments as recommended by your local treatment provider?

Yes or No

If No, why not

5. Was the treatment at the Kairos Healthcare facility helpful to you?

Yes or No

Comments

6. Do you still use the skills you were taught while in residence?

Yes or No

Comments

7. Is there anything that you would like to add to this survey?

Yes or No

Comments