3-1 Survey.docx - 3-1 Survey Creating the Survey Draf Drug Use in Adolescents Name Age Gender Grade Level Date Survey was completed 1 Have you

3-1 Survey.docx - 3-1 Survey Creating the Survey Draf Drug...

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3-1 Survey: Creating the Survey DrafDrug Use in AdolescentsName: Age: Gender: Grade Level: Date Survey was completed:1.Have you experimented with drugs?a.Yesb.No c.Prefer not to answer 2.Types of drugs you’ve experimented with: Stimulantsa.Yesb.Noc.N/Ad.Prefer not to answer Depressantsa.Yesb.Noc.N/Ad.Prefer not to answer Hallucinogensa.Yesb.Noc.N/Ad.Prefer not to answer Dissociativesa.Yesb.Noc.N/Ad.Prefer not to answer Opioidsa.Yesb.Noc.N/Ad.Prefer not to answerInhalantsa.Yesb.Noc.N/A
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d.Prefer not to answerCannabisa.Yesb.Noc.N/Ad.Prefer not to answer3.If you answered no to question 2, would you experiment with drugs? a.Yesb.Noc.Prefer not to answer4.What types of drugs are you open to experimenting with?Stimulants
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