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* 1. Which service are you participating in?

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* 2. Are you a:

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* 3. My appointments or programs began at the scheduled time.

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* 4. It was easy for me to get the services I thought I needed.

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* 5. If a friend or family member were in need of services, I would recommend this organization.

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* 6. My wishes about who should and should not receive information about my services were respected.

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* 7. I am treated with dignity and respect by the staff where I receive services.

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* 8. I participated in my treatment planning and my wishes were respected.

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* 9. The staff was willing to help me when I felt that I needed help.

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* 10. As a direct result of the services I receive, I am better able to control my life.

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* 11. I feel safe in the location, (inside and outside the building) where I receive services.

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* 12. The staff helped me achieve my goals.

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* 13. The staff was available when I needed them.

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* 14. The staff shared information with me about services in the community that could help me.

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* 15. The staff listen to what I have to say.

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* 16. It is easy for me to move around the building.

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* 17. The staff understood my way of communicating.

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* 18. If I needed a translator, Cumberland Mountain provided me one.

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* 19. What do you like most about Cumberland Mountain Community Services?

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* 20. What types of things would you like to see Cumberland Mountain Community Services offer?

Thank you for your willingness to share your thoughts.

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