Consumer Satisfaction Survey

This survey will help us to improve our health services for you. Your answers will be kept confidential and will only be used to evaluate and improve the services at Westbrook. Please indicate your agreement or disagreement with each of the statements below.

1. In Which Program Have You Primarily Been Involved?

2. My Opinion of the Services I've Received is:

  Strongly Agree Agree I am Neutral Disagree Strongly Disagree N/A
1. I like the services I receive here.
2. I would recommend this agency to a friend or family member.
3. The location of services is convenient (parking, public transportation, distance, etc.)
4. Services are available at times that are good for me.
5. I am able to see a physician when I need.

3. As a Direct Result of the Services I've Received:

  Strongly Agree Agree I am Neutral Disagree Strongly Disagree N/A
6. I deal better with my daily problems.
7. I am better able to deal with crises or life's problems.
8. I do better in social situations.
9. My problems are not bothering me as much.
10. I feel better about myself.

4. Your feedback is important to us. Please feel free to comment on any of your answers. Also, if there are comments or observations you would like to mention that were not covered by this survey, please feel free to do so.

5. What is the Consumer ID?

6. What was the consumer's discharge status?

Report a problem

T