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Client Satisfaction Survey
1.
Which of the following describes you?
Client
Family/caregiver of client
Other (please specify)
2.
Which of the following services have you utilized at Renew?
Case Management
Therapy
Substance Use Disorder
Medication Management
Housing/Employment Services
WISe Services
Crisis Services
3.
How would you rate your overall satisfaction with services provided at Renew?
1- Very Dissatisfied
2
3
4
5
6
7
8
9
10-Very satisfied
1- Very Dissatisfied
2
3
4
5
6
7
8
9
10-Very satisfied
Comments
4.
How well do the staff at Renew communicate with you about your treatment options?
1- Not well at all
2
3
4
5
6
7
8
9
10- Very well
1- Not well at all
2
3
4
5
6
7
8
9
10- Very well
Comment:
5.
How likely is it that you would recommend Renew to a friend or family member?
1- Not likely at all
2
3
4
5
6
7
8
9
10- Extremely likely
1- Not likely at all
2
3
4
5
6
7
8
9
10- Extremely likely
Comment:
6.
How effectively do the staff at Renew respond to your needs?
1- Not effectively at all
2
3
4
5
6
7
8
9
10- Extremely effectively
1- Not effectively at all
2
3
4
5
6
7
8
9
10- Extremely effectively
Comment:
7.
How comfortable do you feel in the environment at Renew?
1- Not comfortable
2
3
4
5
6
7
8
9
10- Extremely comfortable
1- Not comfortable
2
3
4
5
6
7
8
9
10- Extremely comfortable
Comment:
8.
Which of the following aspects of the facility do you feel need improvement? Select all that apply
Cleanliness
Privacy
Safety
Customer Service
Access to staff
Please explain
9.
If you could change one thing about our facility, what would it be?
10.
What has been your most positive experience at Renew
11.
Would like a Renew Quality Team member to contact you regarding your experience?
No
Yes, if yes please provide contact information below.
Current Progress,
0 of 11 answered
