Westbrook Consumer 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.

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

Strongly Agree

Agree

I am Neutral

Disagree

Strongly Disagree

N/A

1. I like the services I receive here.

1. I like the services I receive here. Strongly Agree

1. I like the services I receive here. Agree

1. I like the services I receive here. I am Neutral

1. I like the services I receive here. Disagree

1. I like the services I receive here. Strongly Disagree

1. I like the services I receive here. N/A

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

2. I would recommend this agency to a friend or family member. Strongly Agree

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

2. I would recommend this agency to a friend or family member. I am Neutral

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

2. I would recommend this agency to a friend or family member. Strongly Disagree

2. I would recommend this agency to a friend or family member. N/A

3. The location of services is convenient (parking, public transportation, distance, etc.)

3. The location of services is convenient (parking, public transportation, distance, etc.) Strongly Agree

3. The location of services is convenient (parking, public transportation, distance, etc.) Agree

3. The location of services is convenient (parking, public transportation, distance, etc.) I am Neutral

3. The location of services is convenient (parking, public transportation, distance, etc.) Disagree

3. The location of services is convenient (parking, public transportation, distance, etc.) Strongly Disagree

3. The location of services is convenient (parking, public transportation, distance, etc.) N/A

4. Services are available at times that are good for me.

4. Services are available at times that are good for me. Strongly Agree

4. Services are available at times that are good for me. Agree

4. Services are available at times that are good for me. I am Neutral

4. Services are available at times that are good for me. Disagree

4. Services are available at times that are good for me. Strongly Disagree

4. Services are available at times that are good for me. N/A

5. I am able to see a physician when I need.

5. I am able to see a physician when I need. Strongly Agree

5. I am able to see a physician when I need. Agree

5. I am able to see a physician when I need. I am Neutral

5. I am able to see a physician when I need. Disagree

5. I am able to see a physician when I need. Strongly Disagree

5. I am able to see a physician when I need. N/A

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

Strongly Agree

Agree

I am Neutral

Disagree

Strongly Disagree

N/A

6. I deal better with my daily problems.

6. I deal better with my daily problems. Strongly Agree

6. I deal better with my daily problems. Agree

6. I deal better with my daily problems. I am Neutral

6. I deal better with my daily problems. Disagree

6. I deal better with my daily problems. Strongly Disagree

6. I deal better with my daily problems. N/A

7. I am better able to deal with crises or life's problems.

7. I am better able to deal with crises or life's problems. Strongly Agree

7. I am better able to deal with crises or life's problems. Agree

7. I am better able to deal with crises or life's problems. I am Neutral

7. I am better able to deal with crises or life's problems. Disagree

7. I am better able to deal with crises or life's problems. Strongly Disagree

7. I am better able to deal with crises or life's problems. N/A

8. I do better in social situations.

8. I do better in social situations. Strongly Agree

8. I do better in social situations. Agree

8. I do better in social situations. I am Neutral

8. I do better in social situations. Disagree

8. I do better in social situations. Strongly Disagree

8. I do better in social situations. N/A

9. My problems are not bothering me as much.

9. My problems are not bothering me as much. Strongly Agree

9. My problems are not bothering me as much. Agree

9. My problems are not bothering me as much. I am Neutral

9. My problems are not bothering me as much. Disagree

9. My problems are not bothering me as much. Strongly Disagree

9. My problems are not bothering me as much. N/A

10. I feel better about myself.

10. I feel better about myself. Strongly Agree

10. I feel better about myself. Agree

10. I feel better about myself. I am Neutral

10. I feel better about myself. Disagree

10. I feel better about myself. Strongly Disagree

10. I feel better about myself. N/A

Westbrook Consumer Survey

Consumer Satisfaction Survey

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1. In Which Program Have You Primarily Been Involved?

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

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

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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.

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5. What is the Consumer ID?

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6. What was the consumer's discharge status?