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1. Rate the services received from this provider

In order to provide the best possible services we would like to know what you think about the services you received during the last six months. Please select the box that best describes your answer. There is space later in the survey to comment further or explain any of your answers. Your answers are confidential unless you choose to include your name.

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* 1. Overall, I am satisfied with the services I received here

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* 2. If I had other choices, I would still get services from this agency.

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* 3. I would recommend this agency to a friend or family member.

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* 4. The location of services was convenient (parking, public transportation, distance, etc)

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* 5. Staff were willing to see me as often as I felt it was necessary.

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* 6. Staff returned my call in 24 hours

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* 7. Services were available at times that were good for me.

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* 8. I was able to get all the services I thought I needed.

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* 9. I was able to see a psychiatrist when I wanted to.

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* 10. Staff here believe that I can grow, change and recover.

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* 11. I felt comfortable asking questions about my treatment and medication.

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* 12. I felt free to complain.

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* 13. I was given information about my rights.

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* 14. Staff encouraged me to take responsibility for how I live my life.

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* 15. Staff told me what side effects to watch out for.

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* 16. Staff respected my wishes about who is and who is not to be given information about my treatment.

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* 17. I, not staff, decided my treatment goals.

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* 18. Staff were sensitive to my cultural background (race, religion, language,etc.)

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* 19. Staff helped me obtain the information I needed so that I could take charge of managing my illness.

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* 20. I was encouraged to use consumer-run programs (support groups, drop-in centers, crisis phone line, etc.).

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