Please Let us know how we're doing.

Question Title

1. Date: (Required.)

Date

Question Title

2. Location: (Required.)

Please select the response which best describes your most recent experience.

Question Title

3. Are you a: (Required.)

Question Title

4. What service was provided:

Question Title

5. The location of services was easy to get to.

Question Title

6. I felt that the services I need were made available to me.

Question Title

7. I felt that the environment was welcoming?

Question Title

8. I felt comfortable asking questions.

Question Title

9. I felt free to share my concerns.

Question Title

10. Staff spoke to me in a way that I understand.

Question Title

11. Staff were friendly.

Question Title

12. Staff were helpful.

Question Title

13. Staff helped me get information I needed about treatment and/or services.

Question Title

14. Staff listened to what I wanted about who should or should not know about my treatment or services.

Question Title

15. Staff were sensitive to my cultural background (language, ethnicity, religion, etc.).

Question Title

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

Question Title

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

Question Title

18. Overall, I am satisfied with my last visit.

Question Title

19. Comments/Suggestions/Concerns:

Thank you for completing the survey! Please click the Done button below to submit. You are able to complete a survey at each appointment or service.

T