Client Feedback Survey

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1. Please check the appropriate box that best corresponds to your current status in the program:

Please check the appropriate box that best corresponds to your current status in the program: Just entering program (under 30 days)

Have been in program at least 30 days

Being discharged, leaving the program or transferring to another treatment program

Post discharge

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2. Office location you received the majority of your services?

Office location you received the majority of your services? Metairie

Mandeville

Arabi

Slidell

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3. Male or Female?

Male or Female? Male

Female

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4. Age?

Age? 14-18 years old

18-25 years old

25-30 years old

30-40 years old

40-50 years old

50-60 years old

60+ years old

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5. Which services have you received at ACER,LLC?

Which services have you received at ACER,LLC? Substance Abuse Assessment/Evaluation

Intensive Outpatient Program

Individual Counseling

Family/Couples Counseling

Anger Management

Suboxone Treatment

Maintenance Group Sessions

Outpatient Group Sesssions Only

Substance Abuse Education

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6. In the past 30 days, how many days have you:

	0 days	1-5 days	5-10 days	10-15 days	15-20 days	20-25 days	everyday
Used alcohol or other drugs?	*In the past 30 days, how many days have you: Used alcohol or other drugs? 0 days	Used alcohol or other drugs? 1-5 days	Used alcohol or other drugs? 5-10 days	Used alcohol or other drugs? 10-15 days	Used alcohol or other drugs? 15-20 days	Used alcohol or other drugs? 20-25 days	Used alcohol or other drugs? everyday
Had a medical problem because of your drinking or using?	Had a medical problem because of your drinking or using? 0 days	Had a medical problem because of your drinking or using? 1-5 days	Had a medical problem because of your drinking or using? 5-10 days	Had a medical problem because of your drinking or using? 10-15 days	Had a medical problem because of your drinking or using? 15-20 days	Had a medical problem because of your drinking or using? 20-25 days	Had a medical problem because of your drinking or using? everyday
Experienced problems at work due to drinking or using?	Experienced problems at work due to drinking or using? 0 days	Experienced problems at work due to drinking or using? 1-5 days	Experienced problems at work due to drinking or using? 5-10 days	Experienced problems at work due to drinking or using? 10-15 days	Experienced problems at work due to drinking or using? 15-20 days	Experienced problems at work due to drinking or using? 20-25 days	Experienced problems at work due to drinking or using? everyday
Had problems with friends or family due to drinking or using?	Had problems with friends or family due to drinking or using? 0 days	Had problems with friends or family due to drinking or using? 1-5 days	Had problems with friends or family due to drinking or using? 5-10 days	Had problems with friends or family due to drinking or using? 10-15 days	Had problems with friends or family due to drinking or using? 15-20 days	Had problems with friends or family due to drinking or using? 20-25 days	Had problems with friends or family due to drinking or using? everyday
Had a hangover or felt bad physically after drinking or using?	Had a hangover or felt bad physically after drinking or using? 0 days	Had a hangover or felt bad physically after drinking or using? 1-5 days	Had a hangover or felt bad physically after drinking or using? 5-10 days	Had a hangover or felt bad physically after drinking or using? 10-15 days	Had a hangover or felt bad physically after drinking or using? 15-20 days	Had a hangover or felt bad physically after drinking or using? 20-25 days	Had a hangover or felt bad physically after drinking or using? everyday
Operated a vehicle while under the influence of alcohol or other drugs?	Operated a vehicle while under the influence of alcohol or other drugs? 0 days	Operated a vehicle while under the influence of alcohol or other drugs? 1-5 days	Operated a vehicle while under the influence of alcohol or other drugs? 5-10 days	Operated a vehicle while under the influence of alcohol or other drugs? 10-15 days	Operated a vehicle while under the influence of alcohol or other drugs? 15-20 days	Operated a vehicle while under the influence of alcohol or other drugs? 20-25 days	Operated a vehicle while under the influence of alcohol or other drugs? everyday
Had emotional/mental health problems?	Had emotional/mental health problems? 0 days	Had emotional/mental health problems? 1-5 days	Had emotional/mental health problems? 5-10 days	Had emotional/mental health problems? 10-15 days	Had emotional/mental health problems? 15-20 days	Had emotional/mental health problems? 20-25 days	Had emotional/mental health problems? everyday

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7. Please rate your agreement with the following questions.

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	N/A
I would recommend ACER,LLC to a friend or family member who needed counseling.	*Please rate your agreement with the following questions. I would recommend ACER,LLC to a friend or family member who needed counseling. Strongly Agree	I would recommend ACER,LLC to a friend or family member who needed counseling. Agree	I would recommend ACER,LLC to a friend or family member who needed counseling. Neutral	I would recommend ACER,LLC to a friend or family member who needed counseling. Disagree	I would recommend ACER,LLC to a friend or family member who needed counseling. Strongly Disagree	I would recommend ACER,LLC to a friend or family member who needed counseling. N/A
The attitude, helpfulness and timeliness of the staff met my expectations.	The attitude, helpfulness and timeliness of the staff met my expectations. Strongly Agree	The attitude, helpfulness and timeliness of the staff met my expectations. Agree	The attitude, helpfulness and timeliness of the staff met my expectations. Neutral	The attitude, helpfulness and timeliness of the staff met my expectations. Disagree	The attitude, helpfulness and timeliness of the staff met my expectations. Strongly Disagree	The attitude, helpfulness and timeliness of the staff met my expectations. N/A
The initial assessment prior to my admission was performed in a timely and informative manner.	The initial assessment prior to my admission was performed in a timely and informative manner. Strongly Agree	The initial assessment prior to my admission was performed in a timely and informative manner. Agree	The initial assessment prior to my admission was performed in a timely and informative manner. Neutral	The initial assessment prior to my admission was performed in a timely and informative manner. Disagree	The initial assessment prior to my admission was performed in a timely and informative manner. Strongly Disagree	The initial assessment prior to my admission was performed in a timely and informative manner. N/A
The staff explained the program rules, expectations and procedures clearly.	The staff explained the program rules, expectations and procedures clearly. Strongly Agree	The staff explained the program rules, expectations and procedures clearly. Agree	The staff explained the program rules, expectations and procedures clearly. Neutral	The staff explained the program rules, expectations and procedures clearly. Disagree	The staff explained the program rules, expectations and procedures clearly. Strongly Disagree	The staff explained the program rules, expectations and procedures clearly. N/A
Staff explained the goals and objectives of my treatment.	Staff explained the goals and objectives of my treatment. Strongly Agree	Staff explained the goals and objectives of my treatment. Agree	Staff explained the goals and objectives of my treatment. Neutral	Staff explained the goals and objectives of my treatment. Disagree	Staff explained the goals and objectives of my treatment. Strongly Disagree	Staff explained the goals and objectives of my treatment. N/A
While in treatment at ACER,LLC, new ways of dealing with life problems were learned.	While in treatment at ACER,LLC, new ways of dealing with life problems were learned. Strongly Agree	While in treatment at ACER,LLC, new ways of dealing with life problems were learned. Agree	While in treatment at ACER,LLC, new ways of dealing with life problems were learned. Neutral	While in treatment at ACER,LLC, new ways of dealing with life problems were learned. Disagree	While in treatment at ACER,LLC, new ways of dealing with life problems were learned. Strongly Disagree	While in treatment at ACER,LLC, new ways of dealing with life problems were learned. N/A
The counselor's presentation of coping skills, educational material and lectures were beneficial to my recovery.	The counselor's presentation of coping skills, educational material and lectures were beneficial to my recovery. Strongly Agree	The counselor's presentation of coping skills, educational material and lectures were beneficial to my recovery. Agree	The counselor's presentation of coping skills, educational material and lectures were beneficial to my recovery. Neutral	The counselor's presentation of coping skills, educational material and lectures were beneficial to my recovery. Disagree	The counselor's presentation of coping skills, educational material and lectures were beneficial to my recovery. Strongly Disagree	The counselor's presentation of coping skills, educational material and lectures were beneficial to my recovery. N/A
The counselors helped me gain insight into my issues.	The counselors helped me gain insight into my issues. Strongly Agree	The counselors helped me gain insight into my issues. Agree	The counselors helped me gain insight into my issues. Neutral	The counselors helped me gain insight into my issues. Disagree	The counselors helped me gain insight into my issues. Strongly Disagree	The counselors helped me gain insight into my issues. N/A
The counselors were helpful in developing resources for me while I was in treatment (i.e. developing aftercare plan, linking to community resources, AA/NA meetings, getting linked to doctor, etc.).	The counselors were helpful in developing resources for me while I was in treatment (i.e. developing aftercare plan, linking to community resources, AA/NA meetings, getting linked to doctor, etc.). Strongly Agree	The counselors were helpful in developing resources for me while I was in treatment (i.e. developing aftercare plan, linking to community resources, AA/NA meetings, getting linked to doctor, etc.). Agree	The counselors were helpful in developing resources for me while I was in treatment (i.e. developing aftercare plan, linking to community resources, AA/NA meetings, getting linked to doctor, etc.). Neutral	The counselors were helpful in developing resources for me while I was in treatment (i.e. developing aftercare plan, linking to community resources, AA/NA meetings, getting linked to doctor, etc.). Disagree	The counselors were helpful in developing resources for me while I was in treatment (i.e. developing aftercare plan, linking to community resources, AA/NA meetings, getting linked to doctor, etc.). Strongly Disagree	The counselors were helpful in developing resources for me while I was in treatment (i.e. developing aftercare plan, linking to community resources, AA/NA meetings, getting linked to doctor, etc.). N/A
The individual/family counseling sessions were helpful.	The individual/family counseling sessions were helpful. Strongly Agree	The individual/family counseling sessions were helpful. Agree	The individual/family counseling sessions were helpful. Neutral	The individual/family counseling sessions were helpful. Disagree	The individual/family counseling sessions were helpful. Strongly Disagree	The individual/family counseling sessions were helpful. N/A
The group sessions were helpful.	The group sessions were helpful. Strongly Agree	The group sessions were helpful. Agree	The group sessions were helpful. Neutral	The group sessions were helpful. Disagree	The group sessions were helpful. Strongly Disagree	The group sessions were helpful. N/A
I had a positive relationship with my counselor.	I had a positive relationship with my counselor. Strongly Agree	I had a positive relationship with my counselor. Agree	I had a positive relationship with my counselor. Neutral	I had a positive relationship with my counselor. Disagree	I had a positive relationship with my counselor. Strongly Disagree	I had a positive relationship with my counselor. N/A
The facility was kept neat and clean.	The facility was kept neat and clean. Strongly Agree	The facility was kept neat and clean. Agree	The facility was kept neat and clean. Neutral	The facility was kept neat and clean. Disagree	The facility was kept neat and clean. Strongly Disagree	The facility was kept neat and clean. N/A

8. Please rate your overall satisfaction on a scale of 1 to 5 (1 being the LOWEST and 5 being the HIGHEST).

	1 - NOT SATISFIED AT ALL	2	3	4	5 - VERY SATISFIED
Please rate your current level of satisfaction with the services you are currently receiving or have received from us?	*Please rate your overall satisfaction on a scale of 1 to 5 (1 being the LOWEST and 5 being the HIGHEST). Please rate your current level of satisfaction with the services you are currently receiving or have received from us? 1 - NOT SATISFIED AT ALL	Please rate your current level of satisfaction with the services you are currently receiving or have received from us? 2	Please rate your current level of satisfaction with the services you are currently receiving or have received from us? 3	Please rate your current level of satisfaction with the services you are currently receiving or have received from us? 4	Please rate your current level of satisfaction with the services you are currently receiving or have received from us? 5 - VERY SATISFIED

Client Feedback Survey
Exit this survey

1. Client Feedback

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1. Please check the appropriate box that best corresponds to your current status in the program:

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2. Office location you received the majority of your services?

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3. Male or Female?

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4. Age?

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5. Which services have you received at ACER,LLC?

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6. In the past 30 days, how many days have you:

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7. Please rate your agreement with the following questions.

8. Please rate your overall satisfaction on a scale of 1 to 5 (1 being the LOWEST and 5 being the HIGHEST).

9. What improvements, if any, could we make in our treatment program that would help you?

10. What difficulties, if any, did you have in accessing our services?

Client Feedback SurveyExit this survey

1. Client Feedback

*1. Please check the appropriate box that best corresponds to your current status in the program:

*2. Office location you received the majority of your services?

*3. Male or Female?

*4. Age?

*5. Which services have you received at ACER,LLC?

*6. In the past 30 days, how many days have you:

*7. Please rate your agreement with the following questions.

8. Please rate your overall satisfaction on a scale of 1 to 5 (1 being the LOWEST and 5 being the HIGHEST).

9. What improvements, if any, could we make in our treatment program that would help you?

10. What difficulties, if any, did you have in accessing our services?

Client Feedback Survey
Exit this survey

*
1. Please check the appropriate box that best corresponds to your current status in the program:

*
2. Office location you received the majority of your services?

*
3. Male or Female?

*
4. Age?

*
5. Which services have you received at ACER,LLC?

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6. In the past 30 days, how many days have you:

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7. Please rate your agreement with the following questions.