Take Back Your Meds Survey

Where do you usually store your medicines?

(please check all that apply)

Medicine lock box

Kitchen

Bathroom

Bedroom

Linen closet

On the counter or table

Do you currently have expired, leftover or otherwise unwanted medicines in your home?

Yes

No

Do you have prescription and/or over-the-counter medicines in your home currently?

Prescription only

Over-the-counter only

Both Prescription and Over-the-counter

If you have unwanted medicines in your home, how many containers do you have currently?

1 - 5

6 - 10

More than 10

How long do you usually store medicines you no longer want or need?

Less than 6 months

6 - 12 months

More than 12 months

Why are the medicines in your home leftover?

(please check all that apply)

How do you dispose of the medicines you no longer want or need?

(please check all that apply)

A medicine take-back program near me (for example, Bartell Drugs or Group Health)

Take them to a police department

A DEA National Take-Back Event

In the trash

In the trash in a zip lock bag with kitty litter or coffee grounds

Flush down the toilet

Pour down the drain

Do not know how to dispose of medicines

Holding onto medicines to dispose of later

When was the last time you used one of the disposal methods mentioned above?

Less than a month

1 - 6 months

6 - 12 months

More than a year

What are the ages of those living in your home?

(please check all that apply)

0 - 5

6 - 12

13 - 18

19 - 25

26 - 30

31 - 50

Older than 50

Zip Code

How did you hear about our survey?

Take Back Your Meds website

Print material

Facebook

Twitter

DEA Take-Back Event

From a friend or relative

Do you have a personal story of unwanted medicines that you would like to share?

Can we share your story on our website?

Your E-Mail Address ■

Personal tools

Sections

Please fill out our brief survey below

Medicine Disposal Locations

Poison Prevention Tips

Checklist - What You Can Do