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* 1. Which program are you enrolled in?

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* 2. Length of time in treatment (Select all that apply)

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* 3. Which category below includes your age?

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* 4. Are you male or female?

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* 5. Are you White, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific islander, or some other race?

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* 6. Are you a parent?

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* 7. How many children do you have?

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* 8. What are the ages of your children?

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* 9. Do you feel that you were treated with courtesy and respect by staff?

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* 10. How would you rate the staff's attention to privacy and confidentiality?

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* 11. Were you given the opportunity to participate in decisions about your treatment?

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* 12. Is the facility environment safe, clean, and comfortable?

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* 13. Were your financial responsibilities explained clearly to you?

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* 14. How would you rate the overall quality of services you received?

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* 15. Was your sustained recovery plan and Alumni Program reviewed with you by your counselor?

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* 16. My ability to communicate has improved due to my knowledge of motivational interviewing:

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* 17. My level of awareness of the stages of change is:

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* 18. Please rate the skills and tools you learned in the program.

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* 19. Please rate your group experience.

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* 20. Please rate your primary counselor.

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* 21. Who is your primary counselor?

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* 22. Do you have a primary care physician?

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* 23. When was your last primary care visit?

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* 24. If someone you know needs recovery services, would you recommend them to our program?

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* 25. Were Granite Wellness Centers staff effective in letting you know about community resources?

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* 26. What was the most helpful to you in your experience at CoRR?

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* 27. How can we improve our services?

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* 28. At which location(s) do you receive services?

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