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Client Satisfaction Survey
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1.
Clinic where you receive services:
(Required.)
Augusta
Batesville
Bentonville
Berryville
Blytheville
Brinkley
Cabot
Cherokee Village
Clarksville
Clinton
Conway
Danville
Fayetteville
Forrest City
Harrison
Hazen
Heber Springs
Helena
Huntsville
Jasper
Jonesboro
Lonoke
Marianna
Marshall
Melbourne
Morrilton
Mountain Home
Mountain View
Newport
North Little Rock
Paragould
Perryville
Pocahontas
Russellville
Salem
Searcy
Siloam Springs
Springdale
Trumann
Walnut Ridge
West Memphis
Wynne
Yellville
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2.
Select which program you attend most often:
(Required.)
Haven
Outpatient (clinic, school-based, tele-therapy)
Primary Care (PCP) Services
PROMOTE
RDS (Adult Day Treatment)
Substance Use Residential (Mills)
Therapeutic Communities/CSSP (Level 1 or Level 2)
Therapeutic Day Treatment (TDT - kids)
Therapeutic Foster Care (TFC)
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3.
How would you rate your satisfaction with the comfort and cleanliness of the building?
(Required.)
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
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4.
How would you rate your satisfaction with the accessibility and safety of the building?
(Required.)
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
*
5.
How would you rate your satisfaction with the friendliness and helpfulness of receptionist staff?
(Required.)
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
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6.
How would you rate your satisfaction with the quality of care provided by therapists?
(Required.)
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
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7.
How would you rate your satisfaction with the quality of care provided by paraprofessionals (case managers/QBHP's)?
(Required.)
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
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8.
How would you rate your satisfaction with the quality of care provided by nurses and medical staff?
(Required.)
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
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9.
How would you rate your satisfaction with the way your expressed cultural needs and preferences were met?
(Required.)
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
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10.
How would you rate your overall satisfaction with the services received?
(Required.)
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
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11.
How do you feel right now about the problems that caused you to come to the center for yourself or your family member?
(Required.)
Problems are under control.
Problems are only a small bother.
Problems are are fairly bad, but cause little discomfort.
Problems are bad enough to cause discomfort.
Problems are severe.
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12.
Would you recommend Arisa Health to others?
(Required.)
Yes
No
13.
Please provide any comments regarding your care. These can be concerns you have or good things you want your provider to be aware of.
Current Progress,
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