Victor Community Support Services Satisfaction Survey

1. VCSS Satisfaction Survey

Our goal at Victor is to provide you with exceptional service. Would you please take a moment to provide us with feedback regarding the services you received?
(Please check one for each question)

Question Title

* 1. Please select the site you are completing this survey for.

Barstow

Chico

Fairfield

Grass Valley

Hemet

Lake Elsinore

Manteca

Marysville

Perris

Red Bluff

Redding

San Bernardino

Stockton

Victorville

Victorville Campus

West Sacramento/ Yolo

West San Bernardino

Other (please specify)

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* 2. Please respond to the following:

Date Completed:

Client Age:

Gender:

Ethnicity:

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* 3. Which program did the client/family participate in?

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* 4. Check One:

Client

Parent/Caregiver

Agency/Referral Party

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* 5. Check one:

The client/family is still in treatment

The client/family was discharged

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* 6. Overall I am satisfied with the services I received from Victor.

Very Satisfied

Satisfied

Not Satisfied

Very Unsatisfied

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* 7. The staff was professional and helpful.

Very Satisfied

Satisfied

Not Satisfied

Very Unsatisfied

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* 8. If I was to seek help again, I would use your program.

Very Likely

Likely

Unlikely

Very Unlikely

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* 1. Please select the site you are completing this survey for.

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* 2. Please respond to the following:

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* 3. Which program did the client/family participate in?

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* 4. Check One:

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* 5. Check one:

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* 6. Overall I am satisfied with the services I received from Victor.

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* 7. The staff was professional and helpful.

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* 8. If I was to seek help again, I would use your program.

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* 9. What other information would you like to share with us about our services?