1. Client Feedback

Thank you for taking the time to complete this questionnaire. Your answers will be kept strictly confidential and will be used only by ACER, LLC staff to improve our treamtent program and the services we offer. Your honest answers will help us provide better services to other people in the future.

Question Title

* 1. Please check the appropriate box that best corresponds to your current status in the program:

Question Title

* 2. Office location you received the majority of your services?

Question Title

* 3. How convenient is our location for you?

Question Title

* 4. Male or Female?

Question Title

* 5. Age?

Question Title

* 6. Which services have you received at ACER,LLC?

Question Title

* 7. In the past 30 days, how many days have you:

  0 days 1-5 days 5-10 days 10-15 days 15-20 days 20-25 days everyday
Used alcohol or other drugs?
Had a medical problem because of your drinking or using?
Experienced problems at work due to drinking or using?
Had problems with friends or family due to drinking or using?
Had a hangover or felt bad physically after drinking or using?
Operated a vehicle while under the influence of alcohol or other drugs?
Had emotional/mental health problems?

Question Title

* 8. Please rate your agreement with the following questions.

  Strongly Agree Agree Neutral Disagree Strongly Disagree N/A
I would recommend ACER,LLC to a friend or family member who needed counseling.
The attitude, helpfulness and timeliness of the staff met my expectations.
The initial assessment prior to my admission was performed in a timely and informative manner.
Services were available at convenient times for me.
The staff explained the program rules, expectations and procedures clearly.
Staff explained the goals and objectives of my treatment.
While in treatment at ACER,LLC, new ways of dealing with life problems were learned.
The counselor's presentation of coping skills, educational material and lectures were beneficial to my recovery.
The counselors helped me gain insight into my issues.
The counselors were helpful in developing resources for me while I was in treatment (i.e. developing aftercare plan, linking to community resources, AA/NA meetings, getting linked to doctor, etc.).
Staff members were sensitive to my cultural/ethnic background.
Staff members respected my right to confidentiality.
The individual/family counseling sessions were helpful.
The group sessions were helpful.
I had a positive relationship with my counselor.
The facility was kept neat and clean.

Question Title

* 9. Please rate your overall satisfaction on a scale of 1 to 5 (1 being the LOWEST and 5 being the HIGHEST).

  1 - NOT SATISFIED AT ALL 2 3 4 5 - VERY SATISFIED
Please rate your current level of satisfaction with the services you are currently receiving or have received from us?

Question Title

* 10. What improvements, if any, could we make in our treatment program that would help you?

Question Title

* 11. What difficulties, if any, did you have in accessing our services?

T