* 1. Please select which service you receive. If you receive more than one service you will
have the opportunity to respond to that service later.

* 2. I feel like I have someone to talk to when I am troubled.

* 3. I feel respected by the staff that works with me.

* 4. I feel comfortable asking questions about my treatment.

* 5. Overall, I am satisfied with the services that I receive from Gaston Adolescent Center.

* 6. It is easy for me to access emergency after hours services if I need them.

* 7. I feel like I can voice my concern or complain if I need to without fear.

* 8. I feel like Gaston Adolescent Center and its Staff respect my privacy.

* 9. Gaston Adolescent Center Staff helps me make progress towards my goal.

* 10. Staff encourage me to take responsibility of my actions.

* 11. My relationships with friends and family members have improved since I have started services.

* 12. My worker explains things to me in a way that I understand.

* 13. Staff come to visits on time?

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