Because your input is so valuable to us, we ask that you take a few moments to share your thoughts on how well we have succeeded in helping you reach your recovery goals so far. Your feedback will guide us on our mission to provide the very best possible care at all  times.

Sincere thanks,
the Access Mental Health Agency team

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* 1. How long have you been receiving services at Access?

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* 2. Please indicate below all the services you currently receive from Access. You can select more than one answer

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* 3. If you used to receive more services from us in the past, please tell us the reasons you do not receive them currently.

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* 4. Do you receive services from Access staff outside of our office, such as in your home, school, or other places in the community?

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* 5. I receive community visits from

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* 6. Do you receive community visits from your Access providers as planned?

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* 7. Please rate how strongly you agree with the following statements. If you only see the doctor, please skip this question and go to question 8.

  Strongly Disagree Disagree Agree Strongly Agree Not sure
My counselor and/or caseworker and I talk about things important to my recovery
I feel interested in what my counselor and/or caseworker and I talk about
I feel like my counselor and/or caseworker is interested in working with me
I understand why my counselor and/or caseworker and I talk about certain topics

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* 8. Please rate how strongly you agree with the following statements.

  Strongly Disagree Disagree Agree Strongly Agree Not sure
My Access providers understand my culture
My Access providers spend enough time with me
I can reach my Access providers when I need them
My Access providers include my family in my treatment
I know what goals and services are on my personal treatment plan
My Access providers treat me respectfully
The location of services was convenient for me (things like parking, public transportation, distance from my home)
Staff respect my wishes about who is and who is not to be given information about my treatment.

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* 9. Please tell us about your recovery progress since you first began receiving treatment from us

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* 10. Please read the statements below and choose a number from 1 to 4 for each service to put them order of how helpful you feel each one has been to your recovery.  For example, if you feel talking to the counselor has been the most helpful to you, you would click to the left of that statement and choose "1" and it will move to the top of the list. Then you would choose the second, third, and fourth most helpful services.

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