Survey Form

part 1

questions about you

Q1. Are you accessing this website for you or for a friend/family member?*

Q2. What is your age?*

Q3. What is your gender?*

part 2

Answer these questions on a scale

Q1. The MOUD Hub meets my approval.*

Completely Disagree

Disagree

Neither agree nor disagree

Agree

Completely Agree

Q2. The MOUD Hub is appealing to me.*

Completely Disagree

Disagree

Neither agree nor disagree

Agree

Completely Agree

Q3. I like the MOUD Hub.*

Completely Disagree

Disagree

Neither agree nor disagree

Agree

Completely Agree

Q4. I welcome the MOUD Hub.*

Completely Disagree

Disagree

Neither agree nor disagree

Agree

Completely Agree

part 3

Please fill in the questions below

Question 1

What did you find most helpful? *

What did you find most helpful?*

Question 2

What were you expecting to find that was missing? *

What were you expecting to find that was missing?*

Question 3

This website is constantly evolving to best serve people who use opioids. Do you have any online resources to share with us so that we can make them available to others? *

This website is constantly evolving to best serve people who use opioids. Do you have any online resources to share with us so that we can make them available to others?*

MOUD HUB

Stages of Change

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Survey Title

Assessment Map

1. Which one best describes you:

2. What currently describes you or your family member/friend better?