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* 1. Treatment Provider(s) Name(s):

* 2. What service(s) did you receive?

* 3. I was treated with courtesy by the front desk staff.

* 4. I was treated respectfully by my provider(s).

  Strongly Disagree Disagree Neither Agree/Disagree Agree Strongly Agree N/A
Clinician/Counselor
CBRS/PSR Specialist
Peer Support Specialist
Family Support Specialist
Case Manager
Medication Provider
Substance Abuse Clinician/Counselor

* 5. My treatment provider(s) helped me with my concerns.

  Strongly Disagree Disagree Neither Agree/Disagree Agree Strongly Agree N/A
Clinician/Counselor
CBRS/PSR Specialist
Peer Support Specialist
Family Support Specialist
Case Manager
Medication Provider
Substance Abuse Clinician/Counselor

* 6. I would recommend my treatment provider(s) to others.

  Strongly Disagree Disagree Neither Agree/Disagree Agree Strongly Agree N/A
Clinician/Counselor
CBRS/PSR Specialist
Peer Support Specialist
Family Support Specialist
Case Manager
Medication Provider
Substance Abuse Clinician/Counselor

* 7. The service(s) I received helped me.

  Strongly Disagree Disagree Neither Agree/Disagree Agree Strongly Agree N/A
Counseling 
CBRS/PSR 
Peer Support
Family Support
Case Management
Medication Management
Substance Abuse Treatment

* 8. Overall, I was satisfied with the service(s) I received at LIFE Counseling Center.

* 9. I would recommend LIFE Counseling Center to others.

* 10. Please indicate which best describes you.

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