Compass Health, CQI
1800 Community Drive, Clinton, MO 64735

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* 1. Were you treated politely when you arrived at the front office?

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* 2. Please Rank. 5=highest ranking 1=lowest ranking
Were you treated with respect by the professional staff that you saw today on your visit? (Check all that apply)

  5-High 4 3 2 1-Low
Nurse
Doctor
Community Support Staff/Case Manager
Therapist/Counselor
Other

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* 3. Did you feel comfortable asking questions about your treatment and medication?

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* 4. I decided my treatment goals.

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* 5. Do you think your privacy was maintained in the treatment session?

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* 6. Please Rank. 5=highest ranking 1=lowest ranking.
Is our office:

  5-High 4 3 2 1-Low N/A
Easy to get in and out of?
Comfortable?

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* 7. Identify the "type" of appointment: intake or follow-up.

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* 8. When you arrived, how long was your wait?

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* 9. Did you have a scheduled appointment?

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* 10. Would you recommend family or friends to our services?

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* 11. What location/in what community were your services delivered?

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* 12. Comments:

T