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Thank you for completing this voluntary survey. Your services in this program will not be affected by whether or not you complete this survey. Your answers to this survey are CONFIDENTIAL. They will not be linked to you or affect your participation in this program. Please answer the following questions based on the LAST 6 MONTHS OR if you have not received services for 6 months, just give answers based on the services you have received so far.

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* 1. If I had other choices of providers, I would still choose this agency for my services.

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* 2. I would recommend this agency to a friend or family member.

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* 3. I feel helped by the services I get here.

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* 4. Staff returned my call within 24 hours.

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* 5. Services were available at times that were good for me.

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* 6. Staff here believe that I can grow, change, and recover.

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* 7. Staff encourage me to take responsibility for how I live my life.

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* 8. Staff were sensitive to my cultural background (race, religion, language, age, communication, etc.)

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* 9. My physical needs and preferred language are always accommodated.

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* 10. As a direct result of the services I received, I deal more effectively with daily problems. 

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* 11. As a direct result of the services I received, I do better in school, work, and/or community.

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* 12. What do you like best about the service(s) you are currently receiving?

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* 13. If you could change one thing about your service at Valley CSB, what would it be?

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* 14. Additional Comments?

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