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* 1. Which service are you enrolled in with Strategic Interventions (SI)?

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* 2. Which SI Team serves you?

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* 3. Your Gender

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* 4. Your Age Range

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* 5. SI staff communicates things to me in a way that I can understand.

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* 6. SI Staff includes my ideas in decisions about my treatment.

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* 7. SI Staff treat me, my child, and/or my family with respect and I feel supported.

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* 8. SI services are helpful because the staff spend enough time with me and/or family.

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* 9. I would recommend this program/service/agency to someone else who is in need of services.

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* 10. I am satisfied with the quality of services that I receive from SI.

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* 11. SI Staff is courteous and professional.

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* 12. I am satisfied with the effectiveness of medications prescribed to me by SI and the process of obtaining medications.

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* 13. In the past 12 months, have you experienced any of these roadblocks while receiving services? (Check all that apply)

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* 14. In the past 12 months, have you used the hospital Emergency Room?

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* 15. If you have been to the ER in the past 12 months, what was the main reason for your ER visit? (Select all that apply)

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* 16. Do you have any additional comments, suggestions or success stories? If yes, please share them with us.

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