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Primary Health Choice, Inc. Client Follow-Up Survey

1.Discharge Date(Required.)
Date / Time
As part of Primary Health Choice's ongoing commitment to quality service, please provide feedback regarding your current status since leaving our program. Please complete this survey at your earliest possible convenience. Thank you for allowing us to serve you.
2.Service Location(Required.)
3.Service(Required.)
4.Have you been hospitalized or incarcerated since leaving the program at Primary Health Choice, ? If yes, then why and when?(Required.)
5.Have you been compliant with your medications since leaving the program at Primary Health Choice? Yes or No, If No, why?(Required.)
6.Have you made progress since leaving the program at Primary Health Choice? Yes or No. If No, why?(Required.)
7.Have you felt the need to return to the program or had a elapse since leaving the program at Primary Health Choice?(Required.)
8.Would you tell someone else about the services offered by Primary Health Choice? Yes or No. If No, why?(Required.)