Client Survey
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1. Client Survey, Page 1 of 2

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1. General Experience

	Strongly Disagree	Disagree	Agree	Strongly Agree	N/A
I felt that the Friendship House Intake process was easy to complete.	*General Experience I felt that the Friendship House Intake process was easy to complete. Strongly Disagree	I felt that the Friendship House Intake process was easy to complete. Disagree	I felt that the Friendship House Intake process was easy to complete. Agree	I felt that the Friendship House Intake process was easy to complete. Strongly Agree	I felt that the Friendship House Intake process was easy to complete. N/A
I felt that staff members took the necessary time to listen and understand my needs.	I felt that staff members took the necessary time to listen and understand my needs. Strongly Disagree	I felt that staff members took the necessary time to listen and understand my needs. Disagree	I felt that staff members took the necessary time to listen and understand my needs. Agree	I felt that staff members took the necessary time to listen and understand my needs. Strongly Agree	I felt that staff members took the necessary time to listen and understand my needs. N/A
I was well informed of the requirements and expectations of client residents.	I was well informed of the requirements and expectations of client residents. Strongly Disagree	I was well informed of the requirements and expectations of client residents. Disagree	I was well informed of the requirements and expectations of client residents. Agree	I was well informed of the requirements and expectations of client residents. Strongly Agree	I was well informed of the requirements and expectations of client residents. N/A
I agreed with my treatment plan.	I agreed with my treatment plan. Strongly Disagree	I agreed with my treatment plan. Disagree	I agreed with my treatment plan. Agree	I agreed with my treatment plan. Strongly Agree	I agreed with my treatment plan. N/A
While in the program, my financial needs were met.	While in the program, my financial needs were met. Strongly Disagree	While in the program, my financial needs were met. Disagree	While in the program, my financial needs were met. Agree	While in the program, my financial needs were met. Strongly Agree	While in the program, my financial needs were met. N/A
I was comfortable with my counselor.	I was comfortable with my counselor. Strongly Disagree	I was comfortable with my counselor. Disagree	I was comfortable with my counselor. Agree	I was comfortable with my counselor. Strongly Agree	I was comfortable with my counselor. N/A
My counselor took time to meet with me at least once per week.	My counselor took time to meet with me at least once per week. Strongly Disagree	My counselor took time to meet with me at least once per week. Disagree	My counselor took time to meet with me at least once per week. Agree	My counselor took time to meet with me at least once per week. Strongly Agree	My counselor took time to meet with me at least once per week. N/A
I felt that staff members treated me with respect.	I felt that staff members treated me with respect. Strongly Disagree	I felt that staff members treated me with respect. Disagree	I felt that staff members treated me with respect. Agree	I felt that staff members treated me with respect. Strongly Agree	I felt that staff members treated me with respect. N/A
If a friend were in need of similar help, I would recommend Friendship House to him/her.	If a friend were in need of similar help, I would recommend Friendship House to him/her. Strongly Disagree	If a friend were in need of similar help, I would recommend Friendship House to him/her. Disagree	If a friend were in need of similar help, I would recommend Friendship House to him/her. Agree	If a friend were in need of similar help, I would recommend Friendship House to him/her. Strongly Agree	If a friend were in need of similar help, I would recommend Friendship House to him/her. N/A

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2. Cultural Competence

	Strongly Disagree	Disagree	Agree	Strongly Agree	N/A
The program setting was comfortable.	*Cultural Competence The program setting was comfortable. Strongly Disagree	The program setting was comfortable. Disagree	The program setting was comfortable. Agree	The program setting was comfortable. Strongly Agree	The program setting was comfortable. N/A
The program environment was clean.	The program environment was clean. Strongly Disagree	The program environment was clean. Disagree	The program environment was clean. Agree	The program environment was clean. Strongly Agree	The program environment was clean. N/A
If I needed help filling out forms, help was provided.	If I needed help filling out forms, help was provided. Strongly Disagree	If I needed help filling out forms, help was provided. Disagree	If I needed help filling out forms, help was provided. Agree	If I needed help filling out forms, help was provided. Strongly Agree	If I needed help filling out forms, help was provided. N/A
I felt the services I received were right for me.	I felt the services I received were right for me. Strongly Disagree	I felt the services I received were right for me. Disagree	I felt the services I received were right for me. Agree	I felt the services I received were right for me. Strongly Agree	I felt the services I received were right for me. N/A
I felt that I got the help I needed.	I felt that I got the help I needed. Strongly Disagree	I felt that I got the help I needed. Disagree	I felt that I got the help I needed. Agree	I felt that I got the help I needed. Strongly Agree	I felt that I got the help I needed. N/A
I felt my cultural needs were understood.	I felt my cultural needs were understood. Strongly Disagree	I felt my cultural needs were understood. Disagree	I felt my cultural needs were understood. Agree	I felt my cultural needs were understood. Strongly Agree	I felt my cultural needs were understood. N/A
I felt that my cultural beliefs were respected.	I felt that my cultural beliefs were respected. Strongly Disagree	I felt that my cultural beliefs were respected. Disagree	I felt that my cultural beliefs were respected. Agree	I felt that my cultural beliefs were respected. Strongly Agree	I felt that my cultural beliefs were respected. N/A
I feel that I am connected to the American Indian community.	I feel that I am connected to the American Indian community. Strongly Disagree	I feel that I am connected to the American Indian community. Disagree	I feel that I am connected to the American Indian community. Agree	I feel that I am connected to the American Indian community. Strongly Agree	I feel that I am connected to the American Indian community. N/A
I feel that my involvement with Friendship House has helped me make a connection to the American Indian community.	I feel that my involvement with Friendship House has helped me make a connection to the American Indian community. Strongly Disagree	I feel that my involvement with Friendship House has helped me make a connection to the American Indian community. Disagree	I feel that my involvement with Friendship House has helped me make a connection to the American Indian community. Agree	I feel that my involvement with Friendship House has helped me make a connection to the American Indian community. Strongly Agree	I feel that my involvement with Friendship House has helped me make a connection to the American Indian community. N/A

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3. Service Experience

	Strongly Disagree	Disagree	Agree	Strongly Agree	N/A
I learned new information about American Indian culture.	*Service Experience I learned new information about American Indian culture. Strongly Disagree	I learned new information about American Indian culture. Disagree	I learned new information about American Indian culture. Agree	I learned new information about American Indian culture. Strongly Agree	I learned new information about American Indian culture. N/A
I learned new values related to American Indian culture.	I learned new values related to American Indian culture. Strongly Disagree	I learned new values related to American Indian culture. Disagree	I learned new values related to American Indian culture. Agree	I learned new values related to American Indian culture. Strongly Agree	I learned new values related to American Indian culture. N/A
I can apply new skills related to what was taught through Red Road to Recovery Series.	I can apply new skills related to what was taught through Red Road to Recovery Series. Strongly Disagree	I can apply new skills related to what was taught through Red Road to Recovery Series. Disagree	I can apply new skills related to what was taught through Red Road to Recovery Series. Agree	I can apply new skills related to what was taught through Red Road to Recovery Series. Strongly Agree	I can apply new skills related to what was taught through Red Road to Recovery Series. N/A
I can apply new skills related to what was taught through Talking Circles.	I can apply new skills related to what was taught through Talking Circles. Strongly Disagree	I can apply new skills related to what was taught through Talking Circles. Disagree	I can apply new skills related to what was taught through Talking Circles. Agree	I can apply new skills related to what was taught through Talking Circles. Strongly Agree	I can apply new skills related to what was taught through Talking Circles. N/A
I can apply new skills related to what was taught through Matrix.	I can apply new skills related to what was taught through Matrix. Strongly Disagree	I can apply new skills related to what was taught through Matrix. Disagree	I can apply new skills related to what was taught through Matrix. Agree	I can apply new skills related to what was taught through Matrix. Strongly Agree	I can apply new skills related to what was taught through Matrix. N/A
I can apply new skills related to what was taught through Nutrition/Health classes.	I can apply new skills related to what was taught through Nutrition/Health classes. Strongly Disagree	I can apply new skills related to what was taught through Nutrition/Health classes. Disagree	I can apply new skills related to what was taught through Nutrition/Health classes. Agree	I can apply new skills related to what was taught through Nutrition/Health classes. Strongly Agree	I can apply new skills related to what was taught through Nutrition/Health classes. N/A
I can apply new skills related to what was taught through Drug & Alcohol classes.	I can apply new skills related to what was taught through Drug & Alcohol classes. Strongly Disagree	I can apply new skills related to what was taught through Drug & Alcohol classes. Disagree	I can apply new skills related to what was taught through Drug & Alcohol classes. Agree	I can apply new skills related to what was taught through Drug & Alcohol classes. Strongly Agree	I can apply new skills related to what was taught through Drug & Alcohol classes. N/A
I can apply new skills related to what was taught through Relationship Issues.	I can apply new skills related to what was taught through Relationship Issues. Strongly Disagree	I can apply new skills related to what was taught through Relationship Issues. Disagree	I can apply new skills related to what was taught through Relationship Issues. Agree	I can apply new skills related to what was taught through Relationship Issues. Strongly Agree	I can apply new skills related to what was taught through Relationship Issues. N/A
I can apply new skills related to what was taught through American Indian Crafts.	I can apply new skills related to what was taught through American Indian Crafts. Strongly Disagree	I can apply new skills related to what was taught through American Indian Crafts. Disagree	I can apply new skills related to what was taught through American Indian Crafts. Agree	I can apply new skills related to what was taught through American Indian Crafts. Strongly Agree	I can apply new skills related to what was taught through American Indian Crafts. N/A
I can apply new skills related to what was taught through 12-Step Model.	I can apply new skills related to what was taught through 12-Step Model. Strongly Disagree	I can apply new skills related to what was taught through 12-Step Model. Disagree	I can apply new skills related to what was taught through 12-Step Model. Agree	I can apply new skills related to what was taught through 12-Step Model. Strongly Agree	I can apply new skills related to what was taught through 12-Step Model. N/A
I received a Discharge Plan.	I received a Discharge Plan. Strongly Disagree	I received a Discharge Plan. Disagree	I received a Discharge Plan. Agree	I received a Discharge Plan. Strongly Agree	I received a Discharge Plan. N/A

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