Instructions

Please complete one survey for each program you are involved with at AID. If you are involved with more than one program you would complete two or more surveys. Each survey you complete should be focused only on those experiences within that specific program.

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* 1. What is your relationship with the person receiving services? 

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* 2. Gender of the person receiving services

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* 3. AID Program where person receives services

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* 4. How often are you engaged in services?

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* 5. Is your Plan (including your goals) at AID based on your interests and needs?

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* 6. Are AID staff respectful and courteous in how they treat you?

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* 7. Is it easy to set up a meeting or appointment with AID staff?

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* 8. Do you have supportive relationships outside of AID staff?

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* 9. Do you feel safe where you live?

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* 10. Are you satisfied with how AID helps you achieve your personal, physical and mental health goals?

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* 11. Do you have a paid job in the community?

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* 12. If No, do you want a paid job in the community?

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* 13. Overall, are you satisfied with the services you receive from AID?

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* 14. Do you feel your AID staff work together well?

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* 15. Are you able to receive medication refills as needed?

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* 16. What barriers to services have you experienced? (i.e., Waitlist, Transportation etc.)

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* 17. Do you have any additional comments or feedback for AID Staff?

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* 18. What has benefitted you the most in achieving your treatment plan objectives? What has prevented you from accomplishing what you set out to do by attending services ?

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