Follow-up Survey

Northeastern Center, Inc strives to provide top-quality services to all of its customers. If you have recently received services at Northeastern Center, we would appreciate it if you would take a few minutes and complete the following survey. All of our surveys are confidential and we welcome your concerns or questions (please fill in your name, address and phone number if you would like us to respond to your concerns). Thank you for your time.

Question Title

* 1. How would you rate your symptoms when you started services at NEC?

None (1)

Mild (2)

Moderate (3)

Severe (4)

Most Severe (5)

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* 2. How would you rate your symptoms when you ended services at NEC?

None (1)

Mild (2)

Moderate (3)

Severe (4)

Most Severe (5)

I am still receiving services

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* 3. How would you rate your symptoms at the current time?

None (1)

Mild (2)

Moderate (3)

Severe (4)

Most Severe (5)

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* 4. I believe that NEC services/staff helped me?

Strongly disagree (1)

Disagree (2)

Neither agree nor disagree (3)

Agree (4)

Strongly agree (5)

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* 5. I would return or refer a friend to NEC?

Strongly disagree (1)

Disagree (2)

Neither agree nor disagree (3)

Agree (4)

Strongly agree (5)

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* 6. Rate quality of services based on where you received services Inpatient

Worst (1)

Best - (10)

I am not rating services at Inpatient

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* 7. Rate quality of services based on where you received services Promise House

Worst (1)

Best (10)

I am not rating services at Promise House

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* 8. Rate quality of services based on where you received services SGL 1 (Pioneer Lodge1)

Worst (1)

Best (10)

I am not rating services at SGL 1

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* 9. Rate quality of services based on where you received services SGL2 (Pioneer Lodge 2 - MICA)

Worst (1)

Best (10)

I am not rating services at SGL 2

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* 10. Rate quality of services based on where you received services Clubhouse

Worst (1)

Best (10)

I am not rating services at Clubhouse

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* 11. Rate quality of services based on where you received services DeKalb Outpatient

Worst (1)

Best (10)

I am not rating services at DeKalb Outpatient

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* 12. Rate quality of services based on where you received services LaGrange Outpatient

Worst (1)

Best (10)

I am not rating services at LaGrange Outpatient

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* 13. Rate quality of services based on where you received services Noble Outpatient Kendallville

Worst (1)

Best (10)

I am not rating services at Noble Outpatient

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* 14. Rate quality of services based on where you received services Noble Outpatient Albion

Worst (1)

Best (10)

I am not rating services at Albion Outpatient

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* 15. Rate quality of services based on where you received services Steuben Outpatient

Worst (1)

Best (10)

I am not rating services at Steuben Outpatient

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* 16. Rate quality of services based on where you received services Wraparound

Worst (1)

Best (10)

I am not rating services with Wraparound

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* 17. Comments? (Good or Bad about your experience).

Question Title

* 18. (Optional) Please give us the following information if you would like us to contact you

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number