Community Consumer Satisfaction Survey

This survey is confidential! Please do not show it to your caseworker or any other staff after completing it. Please do not allow staff to complete it for you, unless you need special assistance.

Thank you!

* Please select the agency that referred you to this survey:

* In what county did you receive services?

* Primary program: Substance Abuse or Mental Health?

* What is your gender?

* What is your race? Please choose one.

* Are you Hispanic?

* Person completing survey:

* 1. I was treated with respect.

* 2. I was seen for services on time

* 3. I was able to talk to staff when I needed to.

* 4. I received services when I needed them.

* 5. It was easy for me to get to the office.

* 6. If I had a complaint(s), it was handled well.

* 7. I received services that were very helpful.

* 8. The staff helped me find other services that I needed.

* 9. Overall, I am satisfied with the services that I receive.

* 10. How can we improve our services?

* What is your age?

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