Client Satisfaction Questionnaire If completing this survey on a mobile device please turn the device sideways for better viewing. Question Title * 1. Treatment Provider(s) Name(s): Clinician/Counselor CBRS/PSR Peer Support Specialist Family Support Specialist Medication Manager Substance Abuse Clinician/Counselor Case Manager Question Title * 2. What service(s) did you receive? Counseling Substance Use Treatment CBRS/PSR Peer Support Family Support Case Management Medication Management Question Title * 3. I was treated with courtesy by the front desk staff. Completely Disagree Disagree Neither Agree/Disagree Agree Completely Agree N/A Completely Disagree Disagree Neither Agree/Disagree Agree Completely Agree N/A Comment Question Title * 4. I was treated respectfully by my provider(s). Strongly Disagree Disagree Neither Agree/Disagree Agree Strongly Agree N/A Clinician/Counselor Clinician/Counselor Strongly Disagree Clinician/Counselor Disagree Clinician/Counselor Neither Agree/Disagree Clinician/Counselor Agree Clinician/Counselor Strongly Agree Clinician/Counselor N/A CBRS/PSR Specialist CBRS/PSR Specialist Strongly Disagree CBRS/PSR Specialist Disagree CBRS/PSR Specialist Neither Agree/Disagree CBRS/PSR Specialist Agree CBRS/PSR Specialist Strongly Agree CBRS/PSR Specialist N/A Peer Support Specialist Peer Support Specialist Strongly Disagree Peer Support Specialist Disagree Peer Support Specialist Neither Agree/Disagree Peer Support Specialist Agree Peer Support Specialist Strongly Agree Peer Support Specialist N/A Family Support Specialist Family Support Specialist Strongly Disagree Family Support Specialist Disagree Family Support Specialist Neither Agree/Disagree Family Support Specialist Agree Family Support Specialist Strongly Agree Family Support Specialist N/A Case Manager Case Manager Strongly Disagree Case Manager Disagree Case Manager Neither Agree/Disagree Case Manager Agree Case Manager Strongly Agree Case Manager N/A Medication Provider Medication Provider Strongly Disagree Medication Provider Disagree Medication Provider Neither Agree/Disagree Medication Provider Agree Medication Provider Strongly Agree Medication Provider N/A Substance Abuse Clinician/Counselor Substance Abuse Clinician/Counselor Strongly Disagree Substance Abuse Clinician/Counselor Disagree Substance Abuse Clinician/Counselor Neither Agree/Disagree Substance Abuse Clinician/Counselor Agree Substance Abuse Clinician/Counselor Strongly Agree Substance Abuse Clinician/Counselor N/A Comment Question Title * 5. My treatment provider(s) helped me with my concerns. Strongly Disagree Disagree Neither Agree/Disagree Agree Strongly Agree N/A Clinician/Counselor Clinician/Counselor Strongly Disagree Clinician/Counselor Disagree Clinician/Counselor Neither Agree/Disagree Clinician/Counselor Agree Clinician/Counselor Strongly Agree Clinician/Counselor N/A CBRS/PSR Specialist CBRS/PSR Specialist Strongly Disagree CBRS/PSR Specialist Disagree CBRS/PSR Specialist Neither Agree/Disagree CBRS/PSR Specialist Agree CBRS/PSR Specialist Strongly Agree CBRS/PSR Specialist N/A Peer Support Specialist Peer Support Specialist Strongly Disagree Peer Support Specialist Disagree Peer Support Specialist Neither Agree/Disagree Peer Support Specialist Agree Peer Support Specialist Strongly Agree Peer Support Specialist N/A Family Support Specialist Family Support Specialist Strongly Disagree Family Support Specialist Disagree Family Support Specialist Neither Agree/Disagree Family Support Specialist Agree Family Support Specialist Strongly Agree Family Support Specialist N/A Case Manager Case Manager Strongly Disagree Case Manager Disagree Case Manager Neither Agree/Disagree Case Manager Agree Case Manager Strongly Agree Case Manager N/A Medication Provider Medication Provider Strongly Disagree Medication Provider Disagree Medication Provider Neither Agree/Disagree Medication Provider Agree Medication Provider Strongly Agree Medication Provider N/A Substance Abuse Clinician/Counselor Substance Abuse Clinician/Counselor Strongly Disagree Substance Abuse Clinician/Counselor Disagree Substance Abuse Clinician/Counselor Neither Agree/Disagree Substance Abuse Clinician/Counselor Agree Substance Abuse Clinician/Counselor Strongly Agree Substance Abuse Clinician/Counselor N/A Comment Question Title * 6. I would recommend my treatment provider(s) to others. Strongly Disagree Disagree Neither Agree/Disagree Agree Strongly Agree N/A Clinician/Counselor Clinician/Counselor Strongly Disagree Clinician/Counselor Disagree Clinician/Counselor Neither Agree/Disagree Clinician/Counselor Agree Clinician/Counselor Strongly Agree Clinician/Counselor N/A CBRS/PSR Specialist CBRS/PSR Specialist Strongly Disagree CBRS/PSR Specialist Disagree CBRS/PSR Specialist Neither Agree/Disagree CBRS/PSR Specialist Agree CBRS/PSR Specialist Strongly Agree CBRS/PSR Specialist N/A Peer Support Specialist Peer Support Specialist Strongly Disagree Peer Support Specialist Disagree Peer Support Specialist Neither Agree/Disagree Peer Support Specialist Agree Peer Support Specialist Strongly Agree Peer Support Specialist N/A Family Support Specialist Family Support Specialist Strongly Disagree Family Support Specialist Disagree Family Support Specialist Neither Agree/Disagree Family Support Specialist Agree Family Support Specialist Strongly Agree Family Support Specialist N/A Case Manager Case Manager Strongly Disagree Case Manager Disagree Case Manager Neither Agree/Disagree Case Manager Agree Case Manager Strongly Agree Case Manager N/A Medication Provider Medication Provider Strongly Disagree Medication Provider Disagree Medication Provider Neither Agree/Disagree Medication Provider Agree Medication Provider Strongly Agree Medication Provider N/A Substance Abuse Clinician/Counselor Substance Abuse Clinician/Counselor Strongly Disagree Substance Abuse Clinician/Counselor Disagree Substance Abuse Clinician/Counselor Neither Agree/Disagree Substance Abuse Clinician/Counselor Agree Substance Abuse Clinician/Counselor Strongly Agree Substance Abuse Clinician/Counselor N/A Comment Question Title * 7. The service(s) I received helped me. Strongly Disagree Disagree Neither Agree/Disagree Agree Strongly Agree N/A Counseling Counseling Strongly Disagree Counseling Disagree Counseling Neither Agree/Disagree Counseling Agree Counseling Strongly Agree Counseling N/A CBRS/PSR CBRS/PSR Strongly Disagree CBRS/PSR Disagree CBRS/PSR Neither Agree/Disagree CBRS/PSR Agree CBRS/PSR Strongly Agree CBRS/PSR N/A Peer Support Peer Support Strongly Disagree Peer Support Disagree Peer Support Neither Agree/Disagree Peer Support Agree Peer Support Strongly Agree Peer Support N/A Family Support Family Support Strongly Disagree Family Support Disagree Family Support Neither Agree/Disagree Family Support Agree Family Support Strongly Agree Family Support N/A Case Management Case Management Strongly Disagree Case Management Disagree Case Management Neither Agree/Disagree Case Management Agree Case Management Strongly Agree Case Management N/A Medication Management Medication Management Strongly Disagree Medication Management Disagree Medication Management Neither Agree/Disagree Medication Management Agree Medication Management Strongly Agree Medication Management N/A Substance Abuse Treatment Substance Abuse Treatment Strongly Disagree Substance Abuse Treatment Disagree Substance Abuse Treatment Neither Agree/Disagree Substance Abuse Treatment Agree Substance Abuse Treatment Strongly Agree Substance Abuse Treatment N/A Comment Question Title * 8. Overall, I was satisfied with the service(s) I received at LIFE Counseling Center. Strongly Disagree Disagree Neither Agree/Disagree Agree Strongly Agree N/A Strongly Disagree Disagree Neither Agree/Disagree Agree Strongly Agree N/A Comment Question Title * 9. I would recommend LIFE Counseling Center to others. Strongly Disagree Disagree Neither Agree/Disagree Agree Strongly Agree N/A Strongly Disagree Disagree Neither Agree/Disagree Agree Strongly Agree N/A Comment Question Title * 10. Please indicate which best describes you. Client Parent Guardian Other Done
