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Client Satisfaction Questionnaire

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1.Treatment Provider(s) Name(s):(Required.)
2.What service(s) did you receive?(Required.)
3.I was treated with courtesy by the front desk staff.(Required.)
Completely Disagree
Disagree
Neither Agree/Disagree
Agree
Completely Agree
N/A
4.I was treated respectfully by my provider(s).(Required.)
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.(Required.)
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.(Required.)
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.(Required.)
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.
Strongly Disagree
Disagree
Neither Agree/Disagree
Agree
Strongly Agree
N/A
9.I would recommend LIFE Counseling Center to others.
Strongly Disagree
Disagree
Neither Agree/Disagree
Agree
Strongly Agree
N/A
10.Please indicate which best describes you.