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Genesis Programs Pre-Mid Feedback Survey
Facility Overview
1.
How did you first hear about the Genesis Program?
(Required.)
Word of Mouth
Insurance Company
Alumni
Internet
Medical Doctor
Therapist
Psychiatrist
Psychologist
Other (please specify)
2.
Please rate Genesis on how satisfied you are in the following areas.
(Required.)
1(Satisfied)
2
3(Dissatisfied)
Architecture (e.g. parking, location, accessibility, accommodating group size, etc.)
1(Satisfied)
2
3(Dissatisfied)
Environment (e.g. cleanliness, furniture, lighting, room decor, etc.)
1(Satisfied)
2
3(Dissatisfied)
Employment (e.g. accommodations for work/school schedules, vocational referrals and assistance, etc.)
1(Satisfied)
2
3(Dissatisfied)
Transportation (e.g. provide information on public transportation, car pooling, alternative transportation etc.)
1(Satisfied)
2
3(Dissatisfied)
Community Integration (e.g. staff provided 12-step meetings schedule, Aftercare program information, Sober community activities, etc.)
1(Satisfied)
2
3(Dissatisfied)
If you rated a 2 or 3 please specify
