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1. Which service are you participating in? (Required.)

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2. Are you a: (Required.)

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3. My appointments or programs began at the scheduled time. (Required.)

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4. It was easy for me to get the services I thought I needed. (Required.)

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

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6. My wishes about who should and should not receive information about my services were respected. (Required.)

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7. I am treated with dignity and respect by the staff where I receive services. (Required.)

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8. I participated in my treatment planning and my wishes were respected. (Required.)

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9. The staff was willing to help me when I felt that I needed help. (Required.)

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

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

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12. The staff helped me achieve my goals. (Required.)

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13. The staff was available when I needed them. (Required.)

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

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15. The staff listen to what I have to say. (Required.)

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16. It is easy for me to move around the building. (Required.)

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17. The staff understood my way of communicating. (Required.)

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18. If I needed a translator, Cumberland Mountain provided me one. (Required.)

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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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