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Client/Stakeholder Satisfaction Survey
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1.
Region you received support from?
(Required.)
Raleigh
Fayetteville
Jacksonville
Wilmington
Elizabeth City
Smithfield
Wilson
Greenville
Kinston
Goldsboro
Rocky Mount
Other (please specify)
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2.
Are you?
(Required.)
Adult Client
Child/Adolescent Client
Parent/Guardian/Family Member
External Stakeholder/Provider/Other Paid support
Other (please specify)
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3.
What Pride in North Carolina Services did you ( or your family member) receive?
(Required.)
Outpatient Therapy
Intensive in Home services (IIH)
Community Support Team
Medication Management-Psychiatric services
PSR
School Based Therapy
High Fidelity Wraparound
Intensive Home Therapy Services (IHTS)
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4.
Overall I am satisfied with the quality of services provided by Pride in North Carolina.
(Required.)
Strongly Agree
Agree
Disagree
Strongly Disagree
Strongly Agree
Agree
Disagree
Strongly Disagree
Other (please specify)
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5.
I feel that I received what I needed in a timely manner.
(Required.)
Strongly Agree
Agree
Disagree
Strongly Disagree
Strongly Agree
Agree
Disagree
Strongly Disagree
Other (please specify)
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6.
Staff listened and valued my input.
(Required.)
Strongly Agree
Agree
Disagree
Strongly Disagree
Strongly Agree
Agree
Disagree
Strongly Disagree
Other (please specify)
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7.
Staff treated me with respect and honored any cultural needs or preferences.
(Required.)
Strongly Agree
Agree
Disagree
Strongly Disagree
Strongly Agree
Agree
Disagree
Strongly Disagree
Other (please specify)
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8.
I agreed with the goals that are on my treatment plan.
(Required.)
Strongly Agree
Agree
Disagree
Strongly Disagree
Strongly Agree
Agree
Disagree
Strongly Disagree
Other (please specify)
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9.
I know what resources are available in my community.
(Required.)
Strongly Agree
Agree
Disagree
Strongly Disagree
Strongly Agree
Agree
Disagree
Strongly Disagree
Other (please specify)
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10.
I feel safe while receiving services.
(Required.)
Strongly Agree
Agree
Disagree
Strongly Disagree
Strongly Agree
Agree
Disagree
Strongly Disagree
Other (please specify)
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11.
I am doing things better because of the services I received.
(Required.)
Strongly Agree
Agree
Disagree
Strongly Disagree
Strongly Agree
Agree
Disagree
Strongly Disagree
12.
Please add any comments, concerns or feedback that would assist us in program improvement or service delivery.
