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 receiving services via

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* 8. I am satisfied with the referral process (locating treatment)

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* 9. The staff provided good customer service

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* 10. I received feedback from staff regarding services.

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

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* 12. I am likely to recommend Superior Counseling Services, LLC to someone who needs services

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* 13. I have been treated with dignity and respect.

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* 14. I am satisfied with the program orientation.

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* 15. The staff fully met my expectations of the intake process.

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