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* 1. Program/Region

* 2. Are you?

* 3. What Pride In North Carolina Services did you ( or your family member) receive?

* 4. Overall I was satisfied with the quality of services provided by Pride In North Carolina, Inc.

* 5. Overall I feel my/ my child/family member's quality of life has improved or changed for the better since receiving services and supports from Pride In North Carolina, Inc.

* 6. I/My family member is/am better able to handle problems since reciveing services from Pride In North Carolina, Inc.

* 7. I/my family member am/is better able to function at home/school/ work since receiving services from Pride In North Carolina, Inc.

* 8. Pride In North Carolina, Inc. staff treated me with respect and honored any culturally needs or preferences I requested.

* 9. What specifically were some of the cultural needs/preferences you requested or expressed while in treatment?

* 10. My (or my family member's) discharge from Pride In North Carolina, Inc. was planned and appropriate.

* 11. Was your discharge due to:

* 12. Following my (or my family member's) discharge my overall wellbeing has:

* 13. I/my family member am/is in need of further services or supports?

* 14. I would like for someone to contact me:

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