We value your input and welcome your honesty in completing this satisfaction survey. Please complete our survey by selecting an answer that best communicates your opinion. After completing the questions, please provide additional comments and suggestions in the space provided.  Please indicate the number that represents your opinion using the following legend:

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* 1. Date

Date

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* 2. Location

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* 3. Race

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* 4. Age

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* 5. Gender

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* 6. Time in the Program

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* 7. I am satisfied with the services I received.

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* 8. I am satisfied with the agency's ongoing customer service.

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* 9. The staff helped me improve my quality of life.

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* 10. I received feedback from the discharge coordinator in a timely manner.

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* 11. All of my questions were answered during discharge.

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* 12. My counselor and other workers made me feel safe during my treatment.

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* 13. I would recommend your organization to someone else.

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* 14. I would return to the program if needed.

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* 15. I believe the program was a benefit to me.

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* 16. I understand why I was discharged from the program.

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* 17. Completed Survey with:

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* 18. Comments and Feedback

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