1. Victor Satisfaction Survey

Our goal at Victor is to provide you with exceptional service. Would you please take a moment to provide us with feedback regarding the services you received?
(Please check one for each question)

1. Please respond to the following:

2. What services did you receive?

3. Check One:

5. Overall I am satisfied with the services I received from Victor.

6. The intake and assessment process was effective and efficient.

7. My questions and concerns were addressed in a timely manner.

8. The program involved me in treatment/service planning.

9. The staff was professional and helpful.

10. Appointments and meetings were scheduled collaboratively.

11. Psychiatric/medication support services were available and appropriate.

12. The staff was respectful of my values and culture.

13. If I was to seek help again, I would use your program.

14. How long have you received services from our agency?

15. What other information would you like to share with us about your services?

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